Age Specific Practice Criteria

MEDICAL TECHNOLOGIST SKILLS CHECKLIST

CHECK PROFICIENCY / 1 / 2 / 3 / 4 /
GENERAL
Phlebotomy:
Pediatric
Geriatric
General
Blood Culture Collection
Blood alcohol Collection
Finger Stick
Heel Stick
Butterfly
Knowledge of Tub Types & Uses (anticoagulants)
Operation of Centrifuge
Pipetting
M.L.A
To Deliver
To Contain
Volumetric
Use of Balance (weighing)
Calculation for solution Preparation (Molarity, Molality)
Basic Safety Guidelines: (gloves, Goggles, Masks)l
Autoclave & Decontamination Procedures
Infection Control
Haz. Com Knowledge
Ability to Write Procedures

Name______

Date______

CHECK PROFICIENCY / 1 / 2 / 3 / 4 /
Computer Systems Used:
CHEMISTRY
Quality Control Requirements & Documentation
Knowledge of Reference Ranges & Panic Values
Acetone Analysis
Osmolality
CSF Protein
Electrophoresis
Immunoelectrophoresis
Atomic Absorption
Thin Layer Chromatography
Gas Chromatography
Stool Analysis (Fecal Fats)
Arterial Blood Gas
Drug Monitoring
Electrolytes
Main Chemistry Unit:
Other:
RIA/EIA/IMMUOASSAYS
Quality Control Requirements & Documentation
Knowledge of Reference Ranges & Panic Values
CHECK PROFICIENCY / 1 / 2 / 3 / 4 /
Blood Bank (Continued)
Freezing Blood
Cold Agglutinins
Donor Unit Collections
Blood Irradiation
Plasmaphoresis
Plateletphoresis
Emergency Release
Special Blood Typing Kell, Kidd, Duffy, RH-HR, MNS, Lewis, P
Automated Instrumentation
MICROBIOOGY/VIROLOGY
Quality control Requirements & Documentation
Gram Stain
Acid Fast Stain (Kinyoun)
Acid Fast Stain (Fluor)
India Ink
Western Mount-Motility
Darkfield
KOH Prep
Culture Plating
Organism Identification
Sensitivities:
K.B
M.I.C.
Blood Culture
Anaerobic Culture
Anaerobic Identification
Occult Blood
Ova & Parasite Identification:
CHECK PROFICIENCY / 1 / 2 / 3 / 4 /
RIA/EIA/IMMUOASSAYS
Radiation Safety Techniques
Background Counts
Data Reduction
Curves/Regressions
Thyroid Testing
Hormone Testing
Tumor Markers
B12/Foliates
Hepatitis
HIV Testing
Instrumentation/Gamma Counters
Scintillation Counter
Other RIA Tests/Methodologies:
BLOOD BANK
Quality Control Requirements & Documentation
Patient Identification Procedure
Cross Match
Immediate Spin Cross Match
Type, RH
Antibody Titer
Antibody Identification
Coombs Test
Direct
Indirect
Rhogam Screening
Component Preparation
CHECK PROFICIENCY / 1 / 2 / 3 / 4 /
URINALYSIS (Continued)
Automated Instrumentation:
24 hour Urine Collection
Drug Screening Collection
Chain of Custody Documentation
HEMATOLOGY
Quality Control Requirements & Documentation
Knowledge of Reference Ranges & Panic Values
CBC
Automated
Manual
Differential
Automated
Manual
RBC Morphology
Platelet Morphology
Histogram Interpretation
Scattergram Interpretation
Reticulocyte Count
Platelet Count
Sickle Cell Prep
Eosinophil Count
Sedimentation Rate
Automated
Manual
Bleeding Time
CHECK PROFICIENCY / 1 / 2 / 3 / 4 /
MICROBIOOGY/VIROLOGY
Trichcone
Wet Mount
Myobacteria
Culture
ConcentrationTech.
Identification
Chlamydia Culture
Chlamydia Smear
Cell Culture Tech. (viral)
Virus Isolation
Virus Identification
C Difficele Assay
Malarial Examination
Automated Instrumentation:
URINALYSIS
Macroscopic UA
Microscopic UA
Chemical Analysis
Dip UA
Clinitest
Icotest
Other:
Crystal Identification
Semen Analysis
CHECK PROFICIENCY / 1 / 2 / 3 / 4 /
HEMATOLOGY
Ivy
Duke
PT & PTT
Fibrinogen
Factor Assays
Thrombin Time
Fibrin Split Products/FDP
Platelet Aggregation
Lee-White Clotting Time
Fetal Hemoglobin
Body Fluid Count
Special Stains (PAS, Peroxidase, Leukocyte, Alkaline, Phophatase)
Automated Instrumentation:
SEROLOGY/IMMUNOLOGY
Quality control requirements &
Documentation
Knowledge of Reference Ranges
& Panic Values
FTA-ABS
Immunofluorescence
Nephelometry
Flow Cytometry
DNA Probe Technology
PCR Technology
Western Blot Technology
Rheumatoid Factor
Monospot
Pregnancy Testing
ASO Titer
Radial Immuno Diffusion
Hemagglutination
CHECK PROFICIENCY / 1 / 2 / 3 / 4 /
SEROLOGY/IMMUNOLOGY (Continued)
Rubella Serology
TORCH Studies
T & B Cell Studies
Direct FA
Instrumentation Used:

Age Specific Practice Criteria

A. Newborn/Neonate (birth - 30 days) / F. Adolescents (12 - 18 years)
B. Infant (30 days - 1 year) / G. Young adults (18 - 39 years)
C. Toddler (1 - 3 years) / H. Middle adults (39 - 64 years)
D. Preschooler (3 - 5 years) / I. Older Adults (64+)
E. School age children (5 - 12 years)

Please check the boxes below for each age group for which you have expertise in providing age-appropriate care

Experience with age groups / A / B / C / D / E / F / G / H / I
Able to adapt care to incorporate normal growth and development
Able to adapt method and terminology of patient instructions to their age, comprehension and maturity level.
Can ensure a safe environment reflecting specific needs of various age groups.

My experience is in the following settings

Yrs.Acute Care Yrs.Management

Yrs.Outpatient Setting Yrs.Outpatient Setting

Yrs. Independent Lab Yrs.Mobile Routes

Yrs.Reference Lab

REGISTRATION

State Certification: Exp. Date:

State Certification: Exp. Date:

State Certification: Exp. Date:

ASCP - MLT Yes No

ASCP - HT/HTL Yes No

ASCP - BB Yes No

ASCP - C Yes No

ASCP - CG Yes No

ASCP - CT Yes No

ASCP - H Yes No

ASCP - M Yes No

ASCP - MB Yes No

Cert. Phlebotomy Technician (CBT-ASCP) Yes No

Other: Specify

Medical Laboratory Technician/Medical Technologist/Phlebotomist Skills Checklist, version 5

Key: 1 = No Experience 2 = Some Experience 3 = Moderate Experience 4 = Proficient

LAB INFORMATION SYSTEMS / 1 / 2 / 3 / 4
Cerner
Horizon
Sunquest
Meditech
Orchard
Other Computerized System: Specify
Other Computerized System: Specify

MCNW-F-007, R2 (3/4/2015) Page 5 of 6