SPEECH & LANGUAGE PATHOLOGIST

SKILLS/PROFICIENCY INVENTORY

Please print this out

and send or fax the completed form to us

SLP CFY

NAME: _________________________________________________________________

First Middle Last

DIRECTIONS

By completing this checklist to the best of your ability, you will help us match your skills and the areas of interest with our available assignments. Please place a check (Ö) in the column that most accurately describes your level of experience with each skill.

EXPERIENCE LEVELS

1 = Very Experienced

2 = Experienced

3 = Some Experience

4 = No Experience

Ped- Pediatric Experience

Adult- Adult Experience

COMMUNICATION DISORDERS	1	2	3	4	Ped	Adult
Learning Disability
Low Level Functioning Patients
Mental Retardation
Multi-Handicapped
Non-Oral
Parkinson’s
PDD
Phonological Disorders
Trachs
Traumatic Brain Inquiry
Ventilator Dependent Patients
Videofluroscopy
Voice
DIAGNOSTIC SKILLS
ALPS (Aphasia Language Perf. Scale)
Boston
CADL (Comm. Ability Daily)
CELF-3
Detroit
Minnesota (Schuell)
OWLS (Oral & Written Language Skills)
PICA (Porch Index of Com. Ability)
Token
Western Aphasia Battery (WAB)
MEDICARE GUIDELINES
Daily Treatment Notes
Measurable Goals
Medicare Documentation
Narrative Format
SOAP Notes
PROGRAM DEVELOPMENT
Community Awareness of your Services
Establishing a Caseload
In-Services
Interaction with OT
Interaction with Physician
Interaction with PT
Multidisciplinary Approach

PROGRAM DEVELOPMENT