Name *

First Name

Last Name

Preferred Phone Number *

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Current Skills (Check All That Apply) *

Applications for clinical positions require current licenses or credentials.

Primary Care

MD, DO, PA, NP License

Cardiology Specialty

Dermatology Specialty

Endocrinology Specialty

Gastroenterology Specialty

Gynecology Specialty

Hematology Specialty

Musculoskeletal Specialty

Nephrology Specialty

Neurology Specialty

Podiatry Specialty

Psychiatry Specialty

Pulmonology Specialty

Rheumatology Specialty

RN License

Certified MA

Certified NA

Echocardiogram Tech

EMT (Licensed)

Licensed Dietitian

Provide Disease / Nutrition Education

Scribing

Spanish

Polish

Patient Interview

Patient Scheduling

POC Testing

Supervise Students and Delegate Tasks

Technical Ankle Brachial Indices Procedure

Technical Retinal Photo Procedure

Desires No Patient Interaction

Comfortable with Patient Interaction

Patient Check-in and Check-out

Room a Patient

Discharge Patient / Patient Instructions

Arrange Diagnostic Procedures

Forward Medical Records per Requests

Fax / Verify Documents with an EMR

Medication Assistance Program Processing

Prescription Refill Management

PAD Program Processing

Retinal Scan Program Processing

AthenaNet or similar Electronic Medical Record Administration

Salesforce or similar CRM Administration

Telephone Skills

Telephone Triage

Correspondence

Event Planning

Fundraising

Marketing, Outreach Material Design, and Mass Email Communication

Office Product Proficiency (Office, Excel, PowerPoint)

Data Entry

Manual Labor

Availability (Check All That Apply): *

Monday Morning

Tuesday Morning

Wednesday Morning

Wednesday Evening

Thursday Morning

Friday Morning