Get Phlebotomy Work Experience Documentation Form (route 3) Ascp

The Phlebotomy Work Experience Documentation Form (route 3) Ascp is an essential document for verifying your experience in the field of phlebotomy. This guide will provide step-by-step instructions on how to properly complete the form online, ensuring that you meet the requirements for certification eligibility.

Follow the steps to fill out the Phlebotomy Work Experience Documentation Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete Part I by entering your name, the last four digits of your Social Security number, address, email address, and daytime telephone number.
3. Proceed to Part II, which needs to be filled out by your Immediate Supervisor or Laboratory Management. Provide information regarding your employment, including the date your employment started and ended, and how many hours per week you worked in phlebotomy.
4. Instruct your supervisor to review your phlebotomy experience and mark an X beside each area in which you have demonstrated proficiency under their supervision, including venipunctures and skin punctures.
5. Your supervisor or laboratory management must sign the form, providing their name, certification(s), title, date, email address, telephone number, institution, city, state, and zip code.
6. Ensure that a Letter of Authenticity from your Immediate Supervisor or Laboratory Management is included with this form, printed on original letterhead, stating that the form was completed, signed, and dated.
7. After all sections are completed, you can save changes, download the form for your records, print it, or share it as necessary.

Begin filling out your Phlebotomy Work Experience Documentation Form online today to ensure your certification eligibility.