LETTER OF PHLEBOTOMY EXPERIENCE FOR CALIFORNIA CERTIFICATION - cdph ca 2026

1. Click ‘Get Form’ to open the LETTER OF PHLEBOTOMY EXPERIENCE FOR CALIFORNIA CERTIFICATION in the editor.
2. Begin by entering the 'Laboratory Information'. Fill in the name, address, email, telephone number, and CLIA certificate details of the laboratory where you were employed.
3. Next, complete the 'Applicant Information' section. Provide your name, social security number, address, and telephone number.
4. Indicate your dates of employment and total hours of on-the-job experience in phlebotomy over the last five years. If applicable, specify if you have less than or greater than 1040 hours.
5. List your proficiency areas in phlebotomy as outlined in the form. Ensure that you detail each area accurately.
6. Document any completed procedures on clinical patients as required. Make sure to include successful skin punctures and venipunctures.
7. Finally, have the Laboratory Director sign and print their name along with their license number to validate your experience.

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