Pharmacist Skills Checklist One program to handle all talent management needs from acquisition to development Personal Information This field is hidden when viewing the formOverall ScoreOut of 4Name(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 independentlyPractice Settings/ExperienceAcademia(Required) 1 2 3 4 Ambulatory Care(Required) 1 2 3 4 Clinic(Required) 1 2 3 4 Compounding(Required) 1 2 3 4 Consulting(Required) 1 2 3 4 Correctional Facility (Jail)(Required) 1 2 3 4 Diabetes(Required) 1 2 3 4 Drug Information(Required) 1 2 3 4 Formulary Management(Required) 1 2 3 4 Geriatrics(Required) 1 2 3 4 Home Health(Required) 1 2 3 4 Home Infusion(Required) 1 2 3 4 Hospital– Inpatient(Required) 1 2 3 4 Hospital– Outpatient(Required) 1 2 3 4 Infectious Disease(Required) 1 2 3 4 Long Term Care (LTC)(Required) 1 2 3 4 Mail Order(Required) 1 2 3 4 Military/Government/VA(Required) 1 2 3 4 Nuclear(Required) 1 2 3 4 Oncology(Required) 1 2 3 4 Pain Management(Required) 1 2 3 4 Pediatrics(Required) 1 2 3 4 Pharmaceutical Research(Required) 1 2 3 4 Pharmaceutical Sales(Required) 1 2 3 4 Pharmacy Benefits Management (PBM )(Required) 1 2 3 4 Poison Control(Required) 1 2 3 4 Psychiatric Patient Management(Required) 1 2 3 4 Public Health(Required) 1 2 3 4 Renal Patient Management(Required) 1 2 3 4 Retail– Chain(Required) 1 2 3 4 Retail– Independent(Required) 1 2 3 4 Sub-Acute Care(Required) 1 2 3 4 Veterinary(Required) 1 2 3 4 Other:Pharmacy Software SystemsEtreby(Required) 1 2 3 4 HBS(Required) 1 2 3 4 JASRx(Required) 1 2 3 4 McKesson– 3PM(Required) 1 2 3 4 McKesson– Pharmserv(Required) 1 2 3 4 Meditech(Required) 1 2 3 4 NDC(Required) 1 2 3 4 OPUS– ISM(Required) 1 2 3 4 OSCOR(Required) 1 2 3 4 PDX(Required) 1 2 3 4 PharmNet(Required) 1 2 3 4 Pharmtrak(Required) 1 2 3 4 PROScript 2000(Required) 1 2 3 4 QS1(Required) 1 2 3 4 Renlar(Required) 1 2 3 4 Rescot– Omni-DX(Required) 1 2 3 4 Rx-Link(Required) 1 2 3 4 Speed Script(Required) 1 2 3 4 TechRx(Required) 1 2 3 4 WinPharm(Required) 1 2 3 4 Other:AutomationAccumed/Baker Cells(Required) 1 2 3 4 BAXA– Rapid-Fill (ASF)(Required) 1 2 3 4 BAXA– Repeater Pump(Required) 1 2 3 4 Baxter(Required) 1 2 3 4 Baxter– AUTOMIX Compounder(Required) 1 2 3 4 Baxter– MICROMIX Compounder(Required) 1 2 3 4 Kirby Lester(Required) 1 2 3 4 McKesson– AcuDose-Rx(Required) 1 2 3 4 McKesson– Baker Scale(Required) 1 2 3 4 McKesson– IntelliShelf-Rx(Required) 1 2 3 4 McKesson– MedCarousel(Required) 1 2 3 4 McKesson– ROBOT– Rx(Required) 1 2 3 4 McKesson– PACMED(Required) 1 2 3 4 MTS– Automated Sealers(Required) 1 2 3 4 MTS– Prepackaging(Required) 1 2 3 4 Parata– PACMED(Required) 1 2 3 4 Parata– RDS(Required) 1 2 3 4 Parata– APM(Required) 1 2 3 4 PharmASSIST– RDS ROBOTx(Required) 1 2 3 4 PharmASSIST– ROBOTx(Required) 1 2 3 4 PharmASSIST– SmartCabinet(Required) 1 2 3 4 PharmASSIST– SmartScale(Required) 1 2 3 4 Pyxis(Required) 1 2 3 4 Other:Disease State ManagementAIDS/HIV(Required) 1 2 3 4 Anticoagulation(Required) 1 2 3 4 Asthma(Required) 1 2 3 4 Cardiovascular Disease(Required) 1 2 3 4 Chemotherapy(Required) 1 2 3 4 Cystic Fibrosis(Required) 1 2 3 4 Depression(Required) 1 2 3 4 Diabetes(Required) 1 2 3 4 Dyslipidemia(Required) 1 2 3 4 Hormone Replacement Therapy(Required) 1 2 3 4 Hypertension(Required) 1 2 3 4 Osteoporosis(Required) 1 2 3 4 Pain Management(Required) 1 2 3 4 Smoking Cessation(Required) 1 2 3 4 Transplant(Required) 1 2 3 4 Other:Clinical and Job related ExperienceAdmixture(Required) 1 2 3 4 Adolescent Care(Required) 1 2 3 4 Aseptic Techniques(Required) 1 2 3 4 Blister Packs(Required) 1 2 3 4 Cart Check(Required) 1 2 3 4 Cart Fill(Required) 1 2 3 4 Chemotherapy(Required) 1 2 3 4 Computerized Physician Order Entry(Required) 1 2 3 4 Consulting(Required) 1 2 3 4 Discharge Counseling(Required) 1 2 3 4 DME Equipment(Required) 1 2 3 4 Drug Information(Required) 1 2 3 4 Drug Information Rounds(Required) 1 2 3 4 Drug Rehabilitation Programs(Required) 1 2 3 4 Emergency Room(Required) 1 2 3 4 Enteral Nutrition Products(Required) 1 2 3 4 Formulary Management(Required) 1 2 3 4 Geriatric Care(Required) 1 2 3 4 Hazardous Drug Handling(Required) 1 2 3 4 Homeopathic Treatments(Required) 1 2 3 4 Hyperalimentation Calculation(Required) 1 2 3 4 Immunizations(Required) 1 2 3 4 Immunoglobulin Therapy(Required) 1 2 3 4 Incontinence Supplies(Required) 1 2 3 4 Infectious Disease(Required) 1 2 3 4 Infusion Pumps and Systems(Required) 1 2 3 4 Intensive Care (ICU)(Required) 1 2 3 4 IV Preparation(Required) 1 2 3 4 Neonatal Intensive Care (NICU)(Required) 1 2 3 4 Oncology(Required) 1 2 3 4 Ostomy Supplies(Required) 1 2 3 4 OTC selection and recommendations(Required) 1 2 3 4 P&T committee participant(Required) 1 2 3 4 Pain Management(Required) 1 2 3 4 PCA Pumps(Required) 1 2 3 4 Pediatric Care(Required) 1 2 3 4 Poison Control(Required) 1 2 3 4 Psychiatric Care(Required) 1 2 3 4 Retail Compounding(Required) 1 2 3 4 Surgical Supplies(Required) 1 2 3 4 Tocolytic Therapy(Required) 1 2 3 4 TPN Preparation(Required) 1 2 3 4 Transplant Therapy(Required) 1 2 3 4 Urological Supplies(Required) 1 2 3 4 Other:Age Specific CompetenciesInfant (Birth - 1 year)(Required) 1 2 3 4 Preschooler (ages 2-5 years)(Required) 1 2 3 4 Childhood (ages 6-12 years)(Required) 1 2 3 4 Adolescents (ages 13-21 years)(Required) 1 2 3 4 Young Adults (ages 22-39 years)(Required) 1 2 3 4 Adults (ages 40-64 years)(Required) 1 2 3 4 Older Adults (ages 65-79 years)(Required) 1 2 3 4 Elderly (ages 80+ years)(Required) 1 2 3 4 Pharmacokinetic Dosing ofAminoglycosides(Required) 1 2 3 4 Anticoagulation(Required) 1 2 3 4 Digoxin(Required) 1 2 3 4 Lithium(Required) 1 2 3 4 Theophylline(Required) 1 2 3 4 Vancomycin(Required) 1 2 3 4 Other:AuthorizationsLegal Consent(Required) I agree to the terms and 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