PHYSICAL THERAPY SKILLS INVENTORY
PHYSICAL THERAPY SKILLS INVENTORY
Personal Information
Name
*
First
Last
Title / Specialty
*
Email
*
Phone
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Certifications
Advance Life Support Expiration Date
/
MM
/
DD
YYYY
Certified Athletic Trainer Expiration Date
/
MM
/
DD
YYYY
Certified Manual Therapy Expiration Date
/
MM
/
DD
YYYY
Certified Neuro Clinical Specialist Expiration Date
/
MM
/
DD
YYYY
Patient Groups
Adolescent
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Adult
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Geriatric
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Infant
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
NeoNate
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Pediatric
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Specialty Area
Acute Care
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Amputee
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Burns
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Cerebral Vascular Accident
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Head Injury
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Inpatient
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Intensive Care
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Neonatology
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Neurologic
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Oncology
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Outpatient
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Spinal cord Injury
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Sports Injury
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Total Hip replacement
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Total Knee Replacement
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Pediatrics
Inpatient
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Outpatient
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Psychiatric
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Rehabilitation - Inpatient
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Rehabilitation - Outpatient
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
School System
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Sports Medicine
Years Experience
Rehabilitation
Burns
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Cardaic Rehabilitation
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Cerebral Vascular Accident
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Hand Therapy
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Head Injury
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Inpatient
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Neurologic
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Orthopedic
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Outpatient
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Pain Management
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Pulmonary Rehabilitation
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Spinal Cord Injury
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Skilled Nursing
Dysphagia
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Geriatric Rehabilitation
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Long Term Care
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Neurologic
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Orthopedic
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Restorative Nursing
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Equipment & Procedures
Back Injuries
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Cybex
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Eagle
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Ergometer
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Evaluations
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Exercise Equipment
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Functional Capacity Assessment
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Manual Muscle Testing
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Manual Therapy
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Medicare A Documentation
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Medicare B Documentation
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Modalities
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Muscle Re-Education
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Orthotics
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Serial Casting
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Tens
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Traction
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Ultrasound
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Work Capacity Testing
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Wound Care
Extremely Proficient
Perform Wel
Limited Experience
Theory (No Practice)
No Experience
Additional Information
