[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-502526-105":59,"doc-detail-502526-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","ascp-boc-phlebotomy-technician-pbt-examination-structured-program-completion-verification","ASCP BOC Phlebotomy Technician (PBT) Examination - Structured Program Completion Verification","","Structured Program Completion Verification form for the ASCP BOC Phlebotomy Technician (PBT) Examination. Applicants must provide identity and contact details and then have a qualified supervisor complete and sign program eligibility information. The supervisor verifies completion of a two-part structured phlebotomy training program, including required classroom and clinical components, with specific training hours, dates, and clinical performance requirements. A letter of authenticity on institutional letterhead with a wet signature must also be included.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/ascp-boc-phlebotomy-technician-pbt-examination-structured-program-completion-verification/502526/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/ascp-boc-phlebotomy-technician-pbt-examination-structured-program-completion-verification/502526.png","ImageObject",300,407,{"name":92,"@type":93},"Grenda","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-10","2026-10-03",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Who must complete and sign the structured program verification section?","Question",{"text":112,"@type":113},"The applicant’s supervisor, defined as the person who directly oversees the applicant’s technical experience and can verify competency. The supervisor completes the required fields and provides signature and contact information.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What training components are required for eligibility for the PBT examination?",{"text":117,"@type":113},"Eligibility requires successfully completing a two-part structured phlebotomy training program: classroom instruction and clinical training at an accredited/approved laboratory.",{"name":119,"@type":110,"acceptedAnswer":120},"What clinical training outcomes and laboratory criteria are required?",{"text":121,"@type":113},"Clinical requirements include minimum performance of 100 successful unaided venipunctures and orientation in an approved/accredited laboratory. Acceptable laboratories include CMS CLIA, DoD CLIP, JCI, or ISO 15189 accreditation pathways.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},502526,1791689639,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},7971474921005,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Applicant Information  \nMust be completed by the applicant  \nApplicant Name:  \n\n| ASCP Customer ID: |\n| --- |\n| Email Address: |\n| Home Address: |\n\nVerification of Structured Program Completion  \nThis section must be completed and signed by the applicant’s supervisor† who is qualified to verify the applicant’s structured program completion.  \n†The supervisor is defined as the person who directly oversees the applicant’s technical experience, can verify the applicant’s competency, and who may have titles including supervisor, laboratory manager, program director, educator, etc.  \nThis individual, identified above, has applied for the ASCP BOC Phlebotomy Technician (PBT) Examination. To be deemed eligible for this examination, the applicant must have successfully completed a two-part structured phlebotomy training program that includes both classroom instruction and clinical training at an accredited/approved laboratory* . The clinical portion of the two-part program must be arranged by written agreement with the program official and the clinical institution. As the applicant’s supervisor†, please complete the following information:  \n\n| 1. Structured Program Information | Institution Name:  \u003Cbr>Institution Address:   6-digit School Code Number (if applicable):   |  |\n| --- | --- | --- |\n| 2. Classroom Instruction\u003Cbr>Please place an X by each requirement that has been successfully completed. ALL areas are required for eligibility. | Classroom Training Site:  \u003Cbr>Classroom Training Beginning Date: Month  Day  Year \u003Cbr>Classroom Training Completion Date: Month  Day  Year  |  |\n|  |  40 clock hours of classroom training, including:\u003Cbr> Anatomy and physiology of the circulatory system  Laboratory operations (e.g., safety, quality control, etc.) |  Specimen processing and handling\u003Cbr> Specimen collection (including venipunctures and skin punctures) |\n\n3. Clinical Training  \nPlease place an X by each requirement that has been successfully completed. ALL areas are required for eligibility.  \nClinical Training Site at an Approved/Accredited Laboratory*:    \nClinical Training Beginning Date: Month  Day  Year   \nClinical Training Completion Date: Month  Day  Year   \nPlease place an X to indicate that clinical training has been successfully completed, including:  Minimum performance of 100 successful unaided venipunctures  \n Orientation in an approved/accredited laboratory*  \n*Acceptable Laboratory:  \nCMS CLIA certificate of registration, compliance, accreditation; OR DoD CLIP certificate of registration, compliance, accreditation; OR JCI accreditation;  \nOR Accreditation under ISO 15189  \n| 4. Supervisor† Signature and Contact Information\u003Cbr>By signing this form, I, as the applicant’s supervisor,† verify that this applicant has successfully completed a two-part structured phlebotomy training program and that all information is accurate to the best of my knowledge. | Supervisor† Name & Credential(s) Supervisor† Signature\u003Cbr>Supervisor† Email Address |  |\n| --- | --- | --- |\n|  |  | Title |\n|  |  | Date |\n|  |  | Institution Telephone Number |\n\n5. Letter of Authenticity  \nInclude a letter of authenticity from the applicant’s supervisor†.  \nThe letter of authenticity must:  \n• Be printed on original institutional letterhead  \n• State that the documentation form was completed, signed, and dated by the supervisor†.  \n• Contain a wet signature  \n†The supervisor is defined as the person who directly oversees the applicant’s technical experience, can verify the applicant’s competency, and who may have titles including supervisor, laboratory manager, program director, educator, etc.","cbCaihICbAN7BOai","https://ap.wps.com/l/cbCaihICbAN7BOai","pdf",126243,"English","# Applicant Information\n## Verification of Structured Program Completion\n## Structured Program Information\n## Classroom Instruction\n## Clinical Training\n## Supervisor Signature and Contact Information\n## Letter of Authenticity","[{\"question\":\"Who must complete and sign the structured program verification section?\",\"answer\":\"The applicant’s supervisor, defined as the person who directly oversees the applicant’s technical experience and can verify competency. The supervisor completes the required fields and provides signature and contact information.\"},{\"question\":\"What training components are required for eligibility for the PBT examination?\",\"answer\":\"Eligibility requires successfully completing a two-part structured phlebotomy training program: classroom instruction and clinical training at an accredited/approved laboratory.\"},{\"question\":\"What clinical training outcomes and laboratory criteria are required?\",\"answer\":\"Clinical requirements include minimum performance of 100 successful unaided venipunctures and orientation in an approved/accredited laboratory. Acceptable laboratories include CMS CLIA, DoD CLIP, JCI, or ISO 15189 accreditation pathways.\"}]","ASCP BOC Phlebotomy Technician (PBT) Examination - Structured Program Completion Verification | PDF",1791035794]