Dermatology Skills Checklist
   NAME  
   Email-Id
   DATE    
I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Instructions:

This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

 
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

 
Rating Stars (Click)
DEPARTMENT/SERVICE CHIEF EVALUATION-PRIVILEGES PART I 1
2
3
4
History & physical examination
KOH preparation & interpretation
Oil preparation for scabies
Tzanck preparation for herpes
Local anesthesia
Punch biopsy
Shave biopsy
Cryotherapy for benign keratoses & warts
Topical & parental drug therapy
Incision & Drainage (I&D)
Rating Stars (Click)
PRIVILEGES PART II 1
2
3
4
Fungal culture & identification
Dark field examination
Local anesthesia including regional block
Incisional & excisional skin biopsy
Cryosurgery - benign & malignant lesions
Salabrasion
Patch testing
Photopatch testing
Electrolysis
Grenz ray therapy
Hair transplantation
Laser therapy/surgery
Wedge excision lip
Nail matrix surgery
Lip shave/vermilionectomy
Blepharoplasty
Flaps
Sclerotherapy
Rhinophymectomy
Rating Stars (Click)
Ablative cutaneous surgery 1
2
3
4
Cold knife
Electrocoagulation
Electrodessication
Epilation
Rating Stars (Click)
Chemotherapy 1
2
3
4
Cytostatic/cytotoxic agents
Topical
Injectable
Local lesion treatment
Systemic
Immunosuppressive agents
Rating Stars (Click)
Phototherapy 1
2
3
4
UVB
UVA
Psoralen + UVA
Rating Stars (Click)
Dermabrasion 1
2
3
4
Localized
Full face
Rating Stars (Click)
Chemical peels 1
2
3
4
Acid peels
Phenol peels
Other (Specify)
Rating Stars (Click)
Grafts 1
2
3
4
Punch
Split thickness
Full thickness
Rating Stars (Click)
Collagen injection 1
2
3
4
Interpretation of immunofluorescence, direct and indirect, on skin and mucosa
Mohs micrographic surgery