DIALYSIS SKILLS CHECKLIST                                                                                                                                         

This profile is for use by Dialysis nurses with more than one year experience in their discipline and specialty.  It will not be a determining factor for the program.

Please enter your full legal name as it appears on your Social Security Card.

First Name: Last Name: email:      

Please check the boxes below for each age group for which you have provided age appropriate nursing care:

Please indicate your level of experience:   

A.  Theory, no practice     B.  Intermittent     C.  One- Two Years Current Experience  
D.  Two plus years experience, can function independently