Phlebotomy certification. “Drawing blood isn’t a game, this profession should be taken seriously ; therefore, it is my belief that certification should be a law” Crawford stated. (Continued on Page 3 Bottom) Phone number, and Email Ad-dress.
Phlebotomy Certification program for semester: Please circle: F W S/S Year:_____ Call Career Services (734) 677-5115 for Appointment . REV 01/13 Street Number and Name City State Zip County: Phone: ( ) Date of Birth: Email Address
Phlebotomy program is accredited by the State of California Department of Health Services. not accept any other type of CPR certification. Social Security Number _____ 3. Date of Birth
Card Number: State: Security Code: Zip: Phone Number (C or H): Total Amount charged: Email Address: SS #: _ _ School Attended: Program: Phlebotomy Technician Certification (PTC) EKG Technician Certification (ETC) Clinical Medical Assistant Certification(CMAC)*
Current contact phone number on file with the school for notification in the event a class is cancelled or ASCP Phlebotomy Certification Exam fee (once only) my expulsion from the phlebotomy program. 5.
Thank you for your interest in applying for our Phlebotomy Technician Certification Program. NAME MCC ID NUMBER: ADDRESS . STREET CITY STATE ZIP . HOME PHONE understand that my admission to the Phlebotomy
Certification number and can be verified as such through the NHA candidate verification system . Phlebotomy Technician Certification (CPT) Scaled Score 390 EKG Technician Certification (CET) Scaled Score 390 Clinical Medical Assistant Certification
Registered Phlebotomy Technician (RPT) Allied Health Instructor (AHI) Account Number: _____ Exp Date: _____ Signature I have completed a continuing education activity relevant to my certification and the required certificate of completion is attached.
Application for Certification as a CERTIFIED PHLEBOTOMY INSTRUCTOR – CPCI Home Phone Number ( ) I hereby give my authorization to the American Certification Agency for Healthcare Professionals to request necessary
Mailing address (number and street name or P.O. Box number) City State. ZIP code Date of birth a licensed health professional) within my most recent certification period. List current or most recent facility, agency, or organization.
Phlebotomy Technician Program Course Number: HEA 2500-011. http://www.iavalley.edu/ivce/certification/HealthCareersTraining.html Registration and Payment Procedure: Call: 1-800-284-4823, or 752-4645, credit card required.
Name: Number: List of Documents and Information Needed: Completed Application Physical Examination Form Prior to graduation the student will be eligible to challenge the National Health Career Association’s certification exam, Certified Phlebotomy Technician (CPT).
**Phlebotomy application requires a Calhoun Student C number** Current Certification card-must not expire during semester enrolled I have reviewed the Essential Functions for this program and I certify that to the best of my knowledge I have the
The 90 hour Phlebotomy Technician Program prepares professionals to collect blood specimens from http://www.iavalley.edu/ivce/certification/HealthCareersTraining.html Registration and Payment Procedure: ____ Charge to my MasterCard/Visa, Account number _____ Expiration date
PHLEBOTOMY CLASS REQUIREMENTS State of California DHHS/LFS Certification Fees (online): $100.00 – This application is done online after student has I UNDERSTAND MY NAME AND SOCIAL SECURITY NUMBER WILL BE USED TO OBTAIN A BACKGROUND
Dear Prospective Phlebotomy student: (NHA) certification exam for phlebotomists (CPT). Information about this exam will be insurance policy number changes during my clinical program education experience, I will promptly notify
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