Attachment E - Nurse Checklist.xlsx

XLSX spreadsheet 15 KB Posted

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Non-Personal Healthcare Services of various Registered Nurses for Emergency Department, ICU, Perioperative, among others
Solicitation number
75H71021Q00008
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This document contains a checklist for nurse profiles applying for contract positions with the Department of Health and Human Services Indian Health Service. The checklist requires administrative documents such as a resume, identification, licensure, certifications in areas like BCLS and specialty-related certifications. It also requires immunization and physical documents including a recent physical exam, tuberculosis screening, and vaccinations or titers for measles, mumps, rubella, hepatitis B, and varicella. The related federal contract opportunity is for non-personal healthcare services of various registered nurses in specialties including the emergency department, intensive care unit, and perioperative services.

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Sheet1

CONTRACT NURSE PROFILE CHECKLIST
RN NAME: __________________________________________RN Current Phone Number: _____________________________
UNIT APPLYING FOR: __________________________________RN Email Address: ____________________________________
COMPANY: __________________________________________
COMPANY POC & PH #: ________________________________Nurse Availability Date: _________________________________
___________________________________________________
ADMINISTRATIVE DOCUMENTS:Date Rec'd:Attached:Comments:
Current/Updated resume
Finger Print Cards
Two (2) Forms of ID (Driver License, SSN, Passport)
OF-306-Declaration of Federal Employment (revised Oct 2011)
OF-306 Child Care Addendum form (Exp. Date 11/30/18)
OIG Clearance
RN Active License
RN Inactive License
References
Skills Checklist
H-1B Form I-129 (required if non-US citizen)
Copy of VISA with expiration date (required if non-US citizen)
Copy of SSN w/Social Security Administration Verification for Authenticity (required if non-US citizen)
CERTIFICATIONS DOCUMENTS (based on Specialty)
BCLS (Mandatory) Expire Date:
ACLS
TNCC Or Advance Trauma Care Nurse or Trauma Nurse Spec.
PALS
WCON
NRP
Fetal Monitoring Course Certificate
IMMUNIZATION & PHYSICAL DOCUMENTS:
PE (within the Year)
PPD
Chest X-Ray (if PPD positive)
MMR #1 vaccine (required if born after 1956)
MMR #2 vaccine (required if born after 1956)
MMR Titer (required if no vaccines)
Hepatitis B Series #1 (required if no Titer)
Hepatitis B Series #2 (required if no Titer)
Hepatitis B Series #3 (required if no Titer)
Hepatitis B Titer (required if no Titer)
Varicella Vaccine (required if no Titer)
Varicella Titer (required if no vaccines
TDAP Vaccine
Flu vaccine within the year
revised 2/10/16 gc

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