Attachment E - Nurse Profile Checklist.xlsx

XLSX spreadsheet 12 KB Posted

Attached to
Non-Personal Healthcare Services for Emergency Department at the Gallup Indian Medical Center
Solicitation number
75H71025Q00131
Issued by

About this file

The file is a Nurse Profile Checklist template for a non-personal healthcare services contract with the Indian Health Service. The document is designed to capture comprehensive administrative and certification details for Registered Nurses (RNs) applying to work in the Emergency Department at the Gallup Indian Medical Center in New Mexico. The checklist requires documentation including current/updated resume, OIG clearance, active/inactive RN license, references, skills inventories, and various mandatory certifications such as BCLS, ACLS, TNCC, PALS, and specialized nursing course certificates.

The related federal contract opportunity (Solicitation 75H71025Q00131) seeks forty (40) qualified RNs for the Emergency Department, with an unrestricted acquisition strategy that includes small business set-asides: 10 ISBEE (Indigenous Small Business) and 10 Small Businesses. The solicitation emphasizes that personnel submitted by multiple offerors will not be considered, and multiple awards may be possible. The contract is issued by the Department of Health and Human Services Indian Health Service, targeting healthcare staffing needs at the Gallup Indian Medical Center in New Mexico.

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Text version

Sheet1

REGISTERED 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
OIG Clearance
RN Active License
RN Inactive License
2 current References
RN Skills Inventory Checklist
Scrub Tech Skills Inventory Checklist
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
ENPC

revised: SLA 10.18.21

Sheet2

Sheet3

File details come from the government source that posted it. Updated .