Get Started

Licensed Clinical Social Worker Checklist

ASSESSMENT PROCESS * SKILL

PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS: Proficiency I have never done the stated task. I have performed the task/skill infrequently; I require more experience/practic
Health History
Physical Examination and Review of System
Development of Problem List
Development and Revision of Care Plan
Assesses Response to Treatment
Establishes and Revises Goals
Conducts Complete Initial Evaluation
ASSESSMENT PROCESS *FREQUENCY

PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS: Proficiency I have never done the stated task. I have performed the task/skill infrequently; I require more experience/practic
Health History
Physical Examination and Review of System
Development of Problem List
Development and Revision of Care Plan
Assesses Response to Treatment
Establishes and Revises Goals
Conducts Complete Initial Evaluation
DOCUMENTATION * SKILL

PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS: Proficiency I have never done the stated task. I have performed the task/skill infrequently; I require more experience/practic
Initial Assessment and Plan
Skilled Visit Notes
Physician's Orders
Discharge Summary
DOCUMENTATION *FREQUENCY

PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS: Proficiency I have never done the stated task. I have performed the task/skill infrequently; I require more experience/practic
Initial Assessment and Plan
Skilled Visit Notes
Physician's Orders
Discharge Summary
ADHERES TO PLAN OF CARE * SKILL

PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS: Proficiency I have never done the stated task. I have performed the task/skill infrequently; I require more experience/practic
Performs Services as Ordered
Documents according to Plan of Care
Communicates/Coordinates if Appropriate
ADHERES TO PLAN OF CARE *FREQUENCY

PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS: Proficiency I have never done the stated task. I have performed the task/skill infrequently; I require more experience/practic
Performs Services as Ordered
Documents according to Plan of Care
Communicates/Coordinates if Appropriate
EFFECTIVE CASE COORDINATION * SKILL

PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS: Proficiency I have never done the stated task. I have performed the task/skill infrequently; I require more experience/practic
Reports and Documents Key Information to Physician, Supervisor, and Case Manager
Team Member (RN, PT, OT, ST, LPN/LVN)
Community Resources
Attends/Participates in Case Conferences as Required
EFFECTIVE CASE COORDINATION *FREQUENCY

PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS: Proficiency I have never done the stated task. I have performed the task/skill infrequently; I require more experience/practic
Reports and Documents Key Information to Physician, Supervisor, and Case Manager
Team Member (RN, PT, OT, ST, LPN/LVN)
Community Resources
Attends/Participates in Case Conferences as Required
INFECTION CONTROL * SKILL

PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS: Proficiency I have never done the stated task. I have performed the task/skill infrequently; I require more experience/practic
Handwashing
Protective Equipment
Exposure Plan
INFECTION CONTROL *FREQUENCY

PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS: Proficiency I have never done the stated task. I have performed the task/skill infrequently; I require more experience/practic
Handwashing
Protective Equipment
Exposure Plan
ASSESSMENT AND EVALUATION * SKILL

PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS: Proficiency I have never done the stated task. I have performed the task/skill infrequently; I require more experience/practic
Psychosocial Assessment
Financial Assessment
Emotional Assessment
Spiritual Assessment
Terminal Care Assessment
ASSESSMENT AND EVALUATION *FREQUENCY

PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS: Proficiency I have never done the stated task. I have performed the task/skill infrequently; I require more experience/practic
Psychosocial Assessment
Financial Assessment
Emotional Assessment
Spiritual Assessment
Terminal Care Assessment
PATIENT EDUCATION AND CARE PARTICIPATION * SKILL

PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS: Proficiency I have never done the stated task. I have performed the task/skill infrequently; I require more experience/practic
Establish Rapport with Patients/Families
Development of a Realistic and Actionable Goals List
Develops and Implements Teaching Plan
Engage Patients and Families in the Development of a Care Plan based on Identified Problems/Goals
Locate/Identify and Provide Appropriate, Accurate, and up-to-date Community Resources related to Patient Needs
Provision of Anticipatory Guidance when presenting Care Plan
Serve as a Liaison between Patients/Families and Resource Providers
Serve as an Advocate for Patient-Centered Care
Assist the Interdisciplinary Team with Understanding Significant Social and Emotional Factors related to Health Problems
Participate in Case Conference Activities
Participate in Discharge Planning Activities
PATIENT EDUCATION AND CARE PARTICIPATION *FREQUNCY

PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS: Proficiency I have never done the stated task. I have performed the task/skill infrequently; I require more experience/practic
Establish Rapport with Patients/Families
Development of a Realistic and Actionable Goals List
Develops and Implements Teaching Plan
Engage Patients and Families in the Development of a Care Plan based on Identified Problems/Goals
Locate/Identify and Provide Appropriate, Accurate, and up-to-date Community Resources related to Patient Needs
Provision of Anticipatory Guidance when presenting Care Plan
Serve as a Liaison between Patients/Families and Resource Providers
Serve as an Advocate for Patient-Centered Care
Assist the Interdisciplinary Team with Understanding Significant Social and Emotional Factors related to Health Problems
Participate in Case Conference Activities
Participate in Discharge Planning Activities
AGE SPECIFIC COMPETENCIES * SKILL

PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS: Proficiency I have never done the stated task. I have performed the task/skill infrequently; I require more experience/practic
Newborn/Neonate (birth to 30 days)
Infant (31 days to 12 months)
Toddler (1-3 years)
Preschooler (3-5 years)
School age children (5-12 years)
Adolescents (12-18 years)
Young adults (18-39 years)
Middle adults (39-64 years)
Older adults (64-79 years)
Elderly adults (80+ years)
AGE SPECIFIC COMPETENCIES *FREQUENCY

PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS: Proficiency I have never done the stated task. I have performed the task/skill infrequently; I require more experience/practic
Newborn/Neonate (birth to 30 days)
Infant (31 days to 12 months)
Toddler (1-3 years)
Preschooler (3-5 years)
School age children (5-12 years)
Adolescents (12-18 years)
Young adults (18-39 years)
Middle adults (39-64 years)
Older adults (64-79 years)
Elderly adults (80+ years)