Phlebotomy documentation 2026

1. Click ‘Get Form’ to open the Phlebotomy Work Experience Documentation Form in the editor.
2. Begin by filling out Part I. Enter your name, the last four digits of your Social Security number, address, email address, and daytime telephone number in the designated fields.
3. Proceed to Part II, which must be completed by your Immediate Supervisor or Laboratory Management. They will need to verify your work experience for examination eligibility.
4. Instruct your supervisor to fill in the employment dates and weekly hours worked in phlebotomy. They should also mark proficiency areas such as venipunctures and skin punctures.
5. Ensure that your supervisor signs and dates the form, providing their name, title, email address, and contact information.
6. Finally, remind them to include a letter of authenticity on original letterhead confirming that they completed and signed this form.

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