COMPLETELY FILL IN THE SECTIONS BELOW
EMAIL ADDRESS IS REQUIRED. APPLICA-TION
MAY BE MADE ONLINE, CALLED OR FAXED IN,
OR MAILED TO OUR SHELTON OFFICE. A FEE
OF $585.00 IS DUE WITH THE APPLICATION. IF
APPLICATION IS DE-NIED, THE FEE WILL BE
REFUNDED MINUS A $50.00 PROCESSING
FEE. THERE ARE NO REFUNDS FOR
ACCEPTED APPLICATIONS.
865 RIVER ROAD, SUITE 303
SHELTON, CT 06484
PHLEBOTOMY CERTIFICATION CLASS
APPLICATION
Phebotomy Training
AWARD WINNING*
PHLEBOTOMY
CERTIFICATION
CLASS
ONLINE CLASS,
AVAILABLE 24/7.
TEXTBOOK, STUDY
GUIDE, & EXAM FEE
INCLUDED
————————————————————————Full Name (same as billing name)
___________________________________________
Mailing Address Street (same as billing)
___________________________________________
Mailing Address City, State, Zip Code (same as billing)
___________________________________________
Best Phone Number for Contact
___________________________________________
Email Address to Receive Confirmations
___________________________________________
Profession and Credentials (example, Nurse, RN, LPN)
_______________________State: _______________
Professional License or Certification Number & State
___________________________________________
If enrolled in training program enter type & level (1st
year, senior, etc.) and expected graduation date
___________________________________________
Employer /Training Program Name, Location
___________________________________________
May we contact your employer or training program?
___Yes ___No (May be needed for certain professions)
____________________________________________
Supervisor or Training Administrators Phone Number
___Check here to add on our next scheduled In-Person
Lab Class. Total: $585.00 without Lab. Total with Lab:
$860.00. Go to this page for the lab class dates: http://
cart-catalog.piccresource.com/phlebotomy-certification/
Credit Card#:_________________________________
Card Expire Date:___________ Cr. Card Code:______
C O N V E N I E N T O N L I N E C L AS S AV AI L AB L E 2 4 / 7
EXTRAS INCLUDED AT NO
ADDITIONAL CHARGE!
“Online class was excellent, good information. Good
$585.00 FEE INCLUDES:
usable information, presented very well (that) hopefully I
TEXTBOOK - PRINT & E-BOOK,
can apply soon in (the) field. Looking forward to the
POST CLASS ONLINE STUDY
hands on portion, thanks for all of the assistance.”
A.M. of Hacketts Town, New Jersey
GUIDE/ PRACTICE TEST, &
ATTENDEE COMMENTS/ TESTIMONIAL TO OUR
2010 ONLINE PHLEBOTOMY CLASS
NATIONAL EXAM TEST FEE
HEALTHCARE PROFESSIONALS
BECOME CERTIFIED, START TODAY!
HERE IS HOW IT WORKS:
TAKE CLASS ONLINE. AT CONVENIENT TIMES
COMPLETE CLASS WITHIN 4 MONTHS
PERFORM (40) BLOOD DRAWS AT WORK
OR COMPLETE OUR 4 SESSION LAB CLASS
PASS THE NATIONAL CERTIFICATION EXAM
ATTAIN CERTIFICATION IN PHLEBOTOMY
NOTE: THE ONLINE CLASS FEE INCLUDES
THE TEXTBOOK, STUDY GUIDE/PRACTICE
TEST, AND THE NATIONAL EXAM TEST FEE!
ABOUT THE NHA:
The National Healthcareer Association
(NHA) is an allied health medical
certification provider established in
1989 that provides national certification
exams for certain allied health
professions. The NHA has approved the
PICC Resource phlebotomy class to
educate attendees to qualify for the
NHA national examination.
PROGRAM REQUIREMENTS
WHO C AN AP PL Y?:
ATTENDEE EX AMPLES: RN,
HE ALTHCARE PROFES-
LPN/LVN, M D, PA, APRN, CNA,
SION AL S WHO CAN
MA, EMT, PARAMEDI C, A N D
PERFORM PHLEBOT-
OTHER CLINICAL
OMY PROCEDURES PER
TECHNICIANS INVOLVED IN
THEIR STATE PRAC-
HANDS ON PATI ENT
TIC E RE G UL AT I O NS.
CARE.
MANY OPTIONS TO APPLY:
EXPECTED ATTENDEE COURSE OUTCOMES:
Apply online at cartcatalog.piccresource.com
OR call our Orders & Registration Department 24/7
at (888) 459-4913, OR fax
or mail in the application
form on page 2 of this flyer.
Fax to: (888) 842-7442.
Explain the roles and functions of a phlebotomist
Describe methods of effective communication
Describe professional ethics, legal and regulatory issues
Explain safety and infection control practices
Describe anatomy and physiology related to phlebotomy
Identify blood collection equipment and supplies
Explain complications related to phlebotomy procedures
Understand venipuncture and capillary sampling techniques
Explain documentation and transportation procedures
Describe phlebotomy special procedures and considerations
Describe non-blood specimen collection procedures
Explain drug use, toxicology, work place, & sports med. tests
Include credit card info for
called in or faxed applications. Company checks or
money orders may be sent
with mailed in applications to
our mailing address:
865 River Road, Suite 303,
Shelton, CT 06484.
APPROVALS/ ACCREDITATION:
THE PROGRAM CAN BE COMPLETED
ENTIRELY ONLINE WITH DOCUMENTED
BLOOD DRAWS PERFORMED AT WORK
THE NHA IS ACCREDITED BY THE
NA-TIONAL COMMISSION FOR
CREDENTIALS:
CERTIFYING AGENCIES (NCCA). WE ARE
APPROVED BY THE NHA AS A TEST SITE
UNABLE TO PERFORM BLOOD DRAWS
APPROVED TO ADMINISTER THE NHA
AT WORK?: ADD OUR PHLEBOTOMY IN
CERTIFIED PHLEBOTOMY TECHNICIAN
-PERSON LAB CLASS, ATTEND 4 SES-
NATIONAL CERTIFICATION EXAM,
SIONS HELD AT OUR TRAINING CENTER
COMPLETION OF OUR PROGRAM
IN SHELTON, CONNECTICUT $275.00
QUALIFIES THE STUDENT TO SIT FOR
THE NHA EXAM.
THE CLASS HAS BEEN DEVELOPED BY PROFESSIONALS
DEDICATED TO EXCELLENCE: THE INSTRUCTOR IS A RN,
A NATIONALLY CERTIFIED PHLEBOTOMY INSTRUCTOR,
CERTIFIED INFUSION SPECIALIST, AND BOARD CERTIFIED
VASCULAR ACCESS SPECIALIST. *THE PHLEBOTOMY CLASS
CONTENT PRESENTATION PROGRAM WON A CODIE AWARD
IN 2010 FOR EXCELLENCE IN SOFTWARE DEVELOPMENT