Ultrasound Vascular Echo

  • MM slash DD slash YYYY
  • LEVELS OF EXPERIENCE:
    Use the following values to rate your level of experience and/or frequency within the last two years.

    1= No Experience
    2= Limited Experience/ Supervision or Support
    3= Experienced/ Needs Minimal Support
    4= Proficient/ Performs Independently
  • Work Settings
  • 1234
    Adult
    Pediatrics
    Neonatal
    Obstetrics
  • 1234
    High Risk OB
    Maternal/ Fetal Medicine
    ED/ICU
  • General Ultrasound
  • 1234
    Abdominal – Limited/Complet
    Pediatric Abdomen/Pelvis
  • 1234
    Intra-Operative
  • Small Parts
  • 1234
    Breast
    Superficial Masses
  • 1234
    Thyroid
    Testicles
  • Renal/Pelvis
  • 1234
    Renal/Bladde
    Renal Artery Doppler
    Adnexa/Ovaries/Uterus
  • 1234
    Hernia
    Prostate
  • OB/GYN
  • 1234
    1 st trimester
    2 st trimester
    3 st trimester
    Fetal Anatomical Survey
    Inter/Intra-Orbital Measurements
    Fetal Echo
  • 1234
    Lidocaine
    Outflow tracts
    Fingers/Toes
    Nuchal Translucency Screen
    Umbilical Cord Doppler
    Mid-Cerebral Artery Doppler
  • Neonatal
  • 1234
    Head
    Hips
    Spine
    Intussusception
  • 1234
    Abdomen/Pelvis
    Renal/Bladder
    Duodenal Atresia
  • Procedures
  • 1234
    Paracentesis/Thoracentesis
    Amniocentesis
    Fine Needle Aspiration
    Biopsy of above
  • 1234
    Assist with Sonohystogram
    Ultrasound Guided Biopsy/FNA
    Assist with Ovarian Cyst Aspiration
  • Vascular
  • 1234
    Carotid
    Transcerebral Doppler
    Portal System/Shunt Evaluation
    Lower Extremity Venous
    Lower Extremity Arterial
  • 1234
    Abdominal Vasculature
    Renal Artery Duplex
    Upper Extremity Venous
    Upper Extremity Arterial
    Arterial Graft Studies
  • ECHO
  • 1234
    GE
    Siemens
    Philips ATL
    Hitachi
  • 1234
    SonoSite
    Other
    Other
  • ECHO
  • 1234
    Routine
    3-D Echo
    Pedoff Probe
    Transesophageal Echo
    Stress Echo
    Pulmonary Veins
    Suprasternal Notch
    Pediatric Anomalies
    12 lead ECG
    Holter Monitoring
    McKesson
    Horizon
  • 1234
    Pharmacologic Stress Echo
    Post-Cath Echo
    Imaging w/ Contrast Agents
    Sterilization Procedures
    Hepatic Veins
    Pediatric Echo
    Pediatric Post Surgical Scans
    Stress Testing
    Epic
    SCI – Imaging
    Online Reporting
  • Certifications/Registrations
  • This field is for validation purposes and should be left unchanged.