Learning and Development,

Departments & Programs,UW Health,Ambulatory Education,Checklists - Core and Department Specific,Resources


Neurology - Departments & Programs, UW Health, Ambulatory Education, Checklists - Core and Department Specific, Resources


NEUROLOGY - CLINICAL TRAINING CHECKLIST ----- This is due three months from hire date------

Employee Name: __________________________________ Employee Credentials:________ Hire Date: ____________

Clinic Location/ number: _______________________ Employee Number ________________________

*** N/A on checklist indicates that it is not indicated for the employee***
*Refer to appropriate UWMF policy ***Each area should either be discussed or observed by preceptor***

AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Employee is able to gather data relevant to the following:
S/S of Headache/Migraine ie: cluster, tension, acute/chronic or post lumbar puncture
S/S of MS ie: weakness, numbness, hypreflexia, optic neuritis, ataxia, diplopia, vertigo
S/S of ADD, ADHD, & other behavioral disorders ie: inattentive, impulsive,

S/S of Peripheral neuropathy & nerve damage ie: numbness, tingling, weakness, pain.
S/S of CTS ie: numbness, tingling, weakness or pain
S/S of Parkinson’s ie: tremors, muscle weakness, rigidity, shuffling gait
S/S of Myasthenia Gravis(MG) ie: muscle weakness, fatigue, primarily in face & neck
– c/o difficulty, chewing, swallowing & talking

S/S of Spinal Cord Injury (SCI) ie: depends on injury – general signs of paralysis or

S/S of Low Back Pain (LBP) ie: sciatica pain, with pain referred down leg
S/S of Alzheimer’s and dementia ie: memory loss, deterioration of intellectual functions,
apathy, speech , gait, disturbances, disorientation

S/S of TIA and CVA ie: LOC, paralysis, change in pupils (unequal), change in visual
fields, weakness, ptosis, facial, droop, speech, swallow disturbances, confusion

S/S of ALS ie: weakness, twitching, muscles cramps, atrophy, dysarthia, dysphagia,
excessive salivation, spasticity, hyperreflexia

S/S of Head injury & concussion ie: LOC dizziness, unequal pupils, restlessness, HA
S/S of Developmentally delayed ie: slowed cognitive and motor development
Neurological History and Medication History
General S/S of neuro disorder: gait, movement, amnesia, memory loss, aphasia, ataxia,
dizziness, vertigo, tremors, fatigues, muscle weakness, numbness, tingling, pain, syncope,
tinnitus, disorientation, changes in LOC, and visual changes - enters chief complaint.

Obtains vital signs* (Wt, Ht, BP, P), smoking history – Reviews medication list &
allergies, enters pharmacy in order entry screen.

Patient Education- Employee participates in patient/family teaching

AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Health Education - Employee demonstrates knowledge & can discuss with patient:
Teaching medication administration
Specific tests & the results: CT, MRI, MRA, LP, VER, BAER, EMG, EEG, Carotid

Lab results – trough levels for seizure meds
Questions regarding VNS, magnet reordering & VNS interrogating computer
Pain management intensity(0-10 scale), onset, other factors
Types of Pain: Superficial, Referred, and Phantom along with expressions of pain
Intervention: cold, heat, TENS, distraction, relaxation, acupuncture, imagery, narcotics
Elicit pt’s expectations in medical care and pt’s knowledge level/deficit and ability to

Able to identify cultural practices related to care
Able to elicit info regarding relationships w/ significant others & psychosocial health

Employee is able to appropriately care for a patient with the following:
Headache/migraine / cluster headaches
ADD, ADHD, and other behavioral disorders
Peripheral neuropathy and nerve damage
Myasthenia Gravis (MG)
Spinal Cord Injury (SCI)
Back pain- cervical, thoracic and lumbar
Alzheimer’s and dementia
Head injury and concussion
Developmentally delayed
Psychological and Psychiatric disorders: depression, bipolar, schizophrenia

Consults/referrals to other departments (nutrition) or specialists:
PT, OT, Speech Therapy
UW-Pain/Headache Clinic
Psych and Neuro Psych Clinics
Be able to refer to appropriate “other” clinics and physicians as needed
Set up IV treatments* at hospital as needed- IVIG, Methyprednisolone, Tysabri
Set up LPs and other tests at hospital as needed

AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Demonstrate competence in counseling and provide appropriate resources
Refer to specialty support groups
Obtain prior authorization for medications; know resources UW Health &
AMPAC for MS drugs

Prior authorizations for MRI’s, CAT scans, etc. and UW Health resources
Refer to Patient Resources

Neurology Policies
Narcotic Contract – enter in as an “FYI”

Diagnostic/therapeutic tests- Demonstrate competence to assist/set-up/patient

Computer for EMG
Schedule MRI / CT angiograms, PET scans, CT’s, Ultrasounds, and Video EEGs

Equipment/ Supplies
Assure all equipment/supplies are available based on patient needs
Assure all equipment functions before use
Assure all emergency equipment/supplies are current and available at all times
Demonstrate competence in the care of EMG machine
Clean EMG electrodes after each use
Clean basins after used to warm extremities
Put clean linen away (weekly)
Clean exam rooms, restock room,
Maintain and reorder stock medications following pharmacy regulations

Demonstrates knowledge of patient with or needing oxygen therapy

Check drug supply for expiration dates
Administer IM* adult, SQ* adult, ID8, & sublingual meds
DEA Procedures/Controlled Substances Log & Controlled Substances Abuse*
Injections given in the office: Vistaril, Toradol, Promethazine,
Decadron, Zofran, DHE, Imitrex

Able to draw up Dexamethasone and Lidocaine for occipital nerve block
Eye drops used in visual exams done by Dr. Dreizin


AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Administration of Medications - Verbalize appropriate dose, mechanism, side effects,
compatibility List specific medications in each class listed below

Anti-seizures – Depakote, Tegretol, Topamax, Lamictal, Keppra, Mysoline, Neurontin,
Trileptal, Zonegram, Zarontim, Dilantin, Phenobarbital

Narcotics: MS Contin, Percocet, T3, Vicodin
Anti- Parkinson’s – Artane, Sinemet, Comtan, Permax, Mirapex, Requip
Anti-anxiety – keeps patient calm – diazepam/valium, lorazepam, xanax
Thrombolytics thins the blood – heparin, ASA, coumadin, plavix, aggrenox, foltz, TPA
Antidepressants – Celexa, geodon, Paxil, Wellbutrin, Zoloft, Prozac, Imipramine

Migraine – Amerge, Axert, Imitrex, Maxalt, Phrenilin, Ultram, Zomig
NSAIDS – Aleve, Bextra, Celebryx, Vioxx, Ibuprofen, Replax
Alzhiemers – Aricept, Exelon, Reminyl, Naminda
MS - Avonex, Betaseron, Copaxone, Eebif, Gilenya, Aubagio, Tysabri
Neuropathy - Neurontin, Lyrica, Topamax, Carbamazepine, Cymbalta
Sleep - Temazepam, Ambien
Stimulants/ADD Ritalin, Adderall, Concerta, Straterra
Administer IM adult, SQ adult, ID, & sublingual meds- per UWMF policies
DEA Procedures/Controlled Substances Log & Controlled Substances Abuse
Injections :Dilaudid, Vistaril, Toradol, Thorazine, Promethazine, Decadron, Morphine
Able to draw up Dexamethasone and Lidocaine for occipital nerve block

I, _________________________________________ (employee name) have completed the Neurology Training Checklist and attest the information is true and valid. I have
demonstrated or discussed these skills and I am responsible for performing medical care as a Certified Medical Assistant / Licensed Practical Nurse / Registered Nurse (circle one).

__________________________________________________ ___________________ Additional Preceptor Signatures/initials:
Preceptor Date _______________________________

____________________________________________________ ___________________ _______________________________
Supervisor Date
__________________________________________________ ___________________
Provider Date

Status/Recommendations/Comments: _____________________________________________________________________________________
Initially Completed 8-08-02 Reviewed 2/03, 08/03, 08/04 8/05, 8/07, 9/11, 3/12, 6/14, 3/17

 Send the original signed Clinical Training Checklist to Clinical Staff Education - 1035.
 One copy of the signed Clinical Training Checklist should be placed in the clinic’s staff employee’s file, and a copy given to the employee.