OMT Skills One program to handle all talent management needs from acquisition to development Personal Information This field is hidden when viewing the formOverall ScoreName(Required) First Middle Last Last 4 Digits of Social Security NumberEmail(Required) This field is hidden when viewing the formDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyOPHTHALMIC TECHNICIAN SKILLS AND QUALIFICATIONSPerform preliminary exams including taking patient histories, visual acuity, pupil tests, gross confrontational fields, retinoscopy and refractometry, and applanation tonometry.(Required) 1 2 3 4 Assist with routine tests, treatments, and minor surgeries including administering anesthetics and dilating drops, preparing injections and relaying prescriptions to pharmacy.(Required) 1 2 3 4 Familiar with medications and ocular disease processes.(Required) 1 2 3 4 Equipment used (or have knowledge of) includes.(Required) 1 2 3 4 Committed to excellence in patient care and relations.(Required) 1 2 3 4 Assist with front office duties including pulling charts, checking patients in, filing, scheduling appointments, computer input, and assisting with patient flow.(Required) 1 2 3 4 Document and dictate accurate and timely chart notes.(Required) 1 2 3 4 Knowledge of medical office practices and medical terminology.(Required) 1 2 3 4 Computer skills include.(Required) 1 2 3 4 Instruct patients regarding insertion and removal techniques, disinfecting, cleaning, storing and care of contact lenses.(Required) 1 2 3 4 Minor calibration of equipment.(Required) 1 2 3 4 Knowledge of JCAHO standards and regulations.(Required) 1 2 3 4 Bi-lingual English(Required) 1 2 3 4 Articulate, friendly, and effective working with people of different backgrounds and temperaments.(Required) 1 2 3 4 Maintains a positive attitude and enjoys helping people.(Required) 1 2 3 4 Accurately records, remembers, and verbally communicates detailed information.(Required) 1 2 3 4 Adept at quickly engaging each patient, establishing rapport and assessing needs.(Required) 1 2 3 4 Easily establishes rapport with a wide range of people and has a good sense of humor.(Required) 1 2 3 4 Greets patient and introduces self-prior to eye exam.(Required) 1 2 3 4 Explains to patient what they should expect from technician’s work up and from the MDs.(Required) 1 2 3 4 Completes a detailed patient history which includes: past medical history (systemic and ocular), family medical history (systemic and ocular), medication history (systemic and ocular), and the chief complaint (reason for the visit).(Required) 1 2 3 4 Checks patient’s uncorrected (when applicable) and corrected visual acuity for distance (Snellen) and near (Jaeger).(Required) 1 2 3 4 Neutralizes eyeglasses by either manual or automated lensometry. Able to measure prism in spectacles and mark optical centers.(Required) 1 2 3 4 Neutralizes gas permeable or hard contact lenses (if applicable).(Required) 1 2 3 4 Performs auto-refraction prior to MD or OD exam(Required) 1 2 3 4 Performs one or more of the following exams: Ishihara Color Vision, Stereo, W4D, Amsler, confrontational visual fields (CVF), extraocular movements (EOMS), and Titmus stereo testing.(Required) 1 2 3 4 Performs subjective refraction: cross cylinder technique.(Required) 1 2 3 4 Performs applanation or Tonopen tonometry on patient.(Required) 1 2 3 4 Performs angle assessment and pupil assessment prior to dilating patient.(Required) 1 2 3 4 Performs BAT and PAM tests as directed by MD.(Required) 1 2 3 4 Performs corneal pachymetry (appropriate according to specialty).(Required) 1 2 3 4 Performs corneal topography accurately and is able to troubleshoot poor readings or machine difficulties (appropriate according to specialty).(Required) 1 2 3 4 Performs eye irrigation if instructed by MD.(Required) 1 2 3 4 Performs VF’s: HVF, Goldmann, tangent.(Required) 1 2 3 4 Performs GDX (nerve fiber layer) photography.(Required) 1 2 3 4 Knowledge of instruments routinely used in office, such as Vannas scissors, Jeweler’s forceps, punctal dilators and lid specula.(Required) 1 2 3 4 Inserts and removes both a soft and hard contact lens.(Required) 1 2 3 4 Performs eye patching as instructed by MD.(Required) 1 2 3 4 Certified in CPR/First Aid(Required) 1 2 3 4 Accurately measures Blood Pressure and Pulse Rates. Is familiar with O2 tank and how to administer under MDs instructions.(Required) 1 2 3 4 Responsible for care, maintenance, stocking and set-up of assigned room(s).(Required) 1 2 3 4 Maintain strict confidentiality.(Required) 1 2 3 4 SURGICAL ASSISTINGPerforms pupil, muscle, fluorescein dye testing for abrasions, and Schirmer tear testing.(Required) 1 2 3 4 Applies dressings and bandages.(Required) 1 2 3 4 Removes non-imbedded foreign particles with cotton swab.(Required) 1 2 3 4 Conjunctival and corneal cultures.(Required) 1 2 3 4 Orders intraocular lens (co-signed by physician).(Required) 1 2 3 4 Labels medications, explains discharge orders and instructions to patient/family.(Required) 1 2 3 4 DIAGNOSTIC EQUIPMENT USEDA-Scans and Laser Interferometry.(Required) 1 2 3 4 Visual Fields (Humphrey).(Required) 1 2 3 4 Fluorescein Angiography and Fundus Photography.(Required) 1 2 3 4 External Photography.(Required) 1 2 3 4 MINOR SURGERYRemoves sutures.(Required) 1 2 3 4 TECHNICIANClinical optics.(Required) 1 2 3 4 Strabismus screenings.(Required) 1 2 3 4 Neurological, cataract, glaucoma work-up.(Required) 1 2 3 4 Dry eye, trauma, and foreign particle work-up.(Required) 1 2 3 4 AuthorizationsLegal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. 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