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Quality Care Nursing
Age Specific Practice Criteria
 This checklist must be completed by all nursing personnel in addition to the checklist specific to your area of practice.

A. NEWBORN/NEONATE (BIRTH - 3O DAYS)
B. INFANT (30 DAYS - 1 YEAR)
C. TODDLER (1 -3 YEARS)
D. PRESCHOOLER (3 - 5 YEARS)
E. SCHOOL AGE CHILDREN (5 - 12 YEARS)
F. ADOLESCENTS (12 - 18 YEARS)
G. YOUNG ADULTS (18 - 39 YEARS)
H. MIDDLE ADULTS (39 - 64 YEARS)
I. OLDER ADULTS (64+)

Please check the boxes below for each age group you have expertise in providing age-appropriate nursing care.

Name *
E-mail Address *
Able to adapt care to incorporate normal growth and development
Able to adapt method and terminology of patient instructions to their age, comprehension and maturity level
Can ensure a safe environment reflecting specific needs of various age groups
*Explain the age group you have expertise in providing nursing care to. Complete this ONLY if you answered "other" to any of the statements above
  I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. I authorize Quality Care Nursing to release this Skills Checklist to their client facilities in relation to consideratin of employment as a contrac nurse with those facilities.
Electronic Signature *

* Fields marked with an asterisk are required fields

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