Download Phoenix College Phlebotomy Program Information and Application

Phoenix College Phlebotomy Program
Information and Application Packet
PROGRAM INFORMATION:
The Phlebotomy Certificate Program is designed to prepare students to obtain blood specimens by skin puncture
or venipuncture using proper techniques on adults, children and infants. Students in the Phlebotomy Program
will be in contact with potentially infectious blood, tissues, and body fluids. The program is 8.5 credits,
including the prerequisite courses.
OCCUPATION INFORMATION:
Phlebotomists may find employment in reference laboratories, hospitals, insurance companies, outreach
services, patient service centers, research facilities, donor centers and physicians’ offices. The career
opportunities are varied and many. The salaries range from $9.50 to $13.00 per hour.
COST ESTIMATE FOR THE PHLEBOTOMY PROGRAM:
The cost of the program is approximately $850, which includes tuition for all courses, lab/course fees and
clinical externship experience. Textbooks for the program are an additional $70 dollars. If the prerequisites
courses must be taken, an additional cost for textbooks may be required.
HEALTH DECLARATION:
All students must provide documentation of compliance with all health and safety requirements required
to protect patient safety. Only students in compliance are permitted to enroll in Phlebotomy courses if
accepted into the program. Students will meet these requirements by providing the required documentation
described in the application packet during the application process.
Students must be able to fully participate in program activities whether in the classroom, laboratory, or clinical
settings. Students who have a chronic illness or condition must be maintained on current treatment and be able
to implement direct patient care. This is inclusive of externships which may have additional requirements and or
restrictions for participation. Should a student become unable to participate partially or fully in the programs’
activities he/she may be withdrawn from the program.
Invasive procedures are innate in the Phlebotomy program and include but are not limited to venipuncture and
skin punctures. The health care community expects a student who has completed the Phlebotomy Program to
have performed successful venipuncture and skin punctures prior to clinical experience. Therefore, students
must practice on one another during laboratory sessions in this program, with hand and arm venipunctures as
well as skin punctures. Refusing to fully participate in the venipuncture and skin puncture learning process will
result in failure of, or withdrawal from, the program.
The performance of exposure prone procedures presents a recognized risk of percutaneous injury, and—if such
injury occurs—blood is likely to contact the patient’s body cavity, subcutaneous tissues, and /or mucous
membranes. This can pose a material risk to patients and students in the program should the student have a
communicable chronic illness.
Please refer to the following website for the CDC’s MMWR for recommendations for Preventing Transmission of
Human Immunodeficiency Virus and Hepatitis B Virus to Patients During Exposure Prone Invasive Procedures.
http://www.cdc.gov/mmwr/preview/mmwrhtml/00014845.htm
The Phlebotomy Program Director will review on a case by case basis the ability for a student to fully
participate in and complete the program.
ESSENTIAL SKILLS AND FUNCTIONAL ABILITIES FOR PHLEBOTOMY
STUDENTS:
It is essential that Phlebotomy students be able to perform a number of physical activities in the clinical portion
of the program. Students will be required to stand for several hours at a time and perform bending activities as
well as possess manual dexterity.
The clinical Phlebotomy experience also places students under considerable mental and emotional stress as they
undertake responsibilities and duties impacting patients’ lives. Students must be able to demonstrate rational
and appropriate behavior under stressful conditions. Individuals should give careful consideration to the mental
and physical demands of the program prior to submitting an application.
Individuals enrolled in the phlebotomy program must be able to perform essential skills. If a student believes
that he or she cannot meet one or more of the standards without accommodations, the phlebotomy program
director must determine, on an individual basis, whether a reasonable accommodation can be made.
Essential skills and abilities are performance requirements that refer to those physical, cognitive and behavioral
abilities required for satisfactory completion of all aspects of a Phlebotomy program curriculum, and the
development of personal attributes required by the faculty of all students upon completion of the certificate
program. The essential abilities required by the curriculum are in the following areas: motor, sensory,
communication, intellectual (conceptual, integrative, and quantitative abilities for problem solving and
diagnosis) and the behavioral and social aspects of the performance of a phlebotomist.
These are attributes each phlebotomist must possess and the use of a third party for the fulfillment of these
attributes is not adequate.
Motor Skills
Students must possess physical dexterity to master technical and procedural aspects of patient care
including, but not limited to: lifting, sitting, and bending for long periods of time; adequate physical
stamina and energy to carry out taxing duties over long hours; providing care in confined spaces; and
fine motor skills sufficient to handle small equipment safely.
Sensory Abilities
Students must be able to gather information with all senses, especially sight, hearing and manual
dexterity, in order to perform the Phlebotomy process of care.
Communication Skills
Students must be able to communicate effectively in English with accuracy, clarity and efficiency with
patients, their families and other members of the health care team (including spoken and non-verbal
communication, such as interpretation of facial expressions, affect and body language) and work
cooperatively with supervisors, other students, and all other health care team members. Students must be
able to accurately identify patients.
Students must be able to communicate effectively with patients, including gathering information
appropriately, explaining medical information in a patient-centered manner, listening effectively,
recognizing, acknowledging and responding to emotions, and exhibiting sensitivity to social and cultural
differences.
Intellectual Abilities
Students must be able to comprehend and learn factual knowledge from readings and didactic
presentations, gather information independently, analyze and synthesize learned material and apply
information to clinical situations.
Students must be able to develop sound clinical judgment and exhibit well-integrated knowledge about
the phlebotomy process of care, to include: assessment, planning, implementation and evaluation of
phlebotomy services. They must be comfortable with uncertainty and ambiguity in clinical situations,
and seek the advice of others when appropriate.
Behavioral, Social and Professional Abilities
Students must possess the emotional maturity and stability to function effectively under stress that is
inherent in healthcare professions and to adapt to circumstances which are unpredictable or that change
rapidly. They must be able to interact productively, cooperatively and in a collegial manner with
individuals of differing personalities and backgrounds, and be an active contributor to the process of
providing health care by demonstrating the ability to engage in teamwork and team building. They must
demonstrate the ability to identify and set priorities in patient management and in all aspects of their
professional work. They must be punctual and perform work under strict time frames.
Students must be capable of empathetic response to individuals in many circumstances and be sensitive
to social and cultural differences.
Students must exhibit an ethic of professionalism, including the ability to place others’ needs ahead of
their own. They must exhibit compassion, empathy, altruism, integrity, responsibility and tolerance, as
well as demonstrate the ability to exercise the requisite judgment required in the practice of phlebotomy.
ESSENTIAL ABILITIES REQUIREMENTS FOR PROMOTION AND RETENTION
SIGNATURE
I have read and have had the opportunity to have all of my questions answered regarding the Essential
Abilities Requirements for Promotion and Retention in the Phoenix College Phlebotomy Program. My
signature represents that I understand and will abide by these requirements.
________________________________
Signature/date
*please note, it is a requirement for this statement to be signed*
* if this statement is not signed, the application will not be considered for acceptance*
Phoenix College Phlebotomy Program
Application Packet
We appreciate your interest in the Phoenix College Phlebotomy Program. Follow this checklist
carefully to ensure that your application and documentation are complete and in order for the
selection committee. It is the applicant’s responsibility to verify that the application is complete.
An adviser may not be able to meet with every student and is NOT responsible for verifying the
completeness of the application.
The following items must be submitted with this packet for the application to be processed and
the applicant to be considered for admission to the program:
Completed Phlebotomy Program Application including providing signed “Essential Abilities
Requirements for Promotion and Retention” statement
Proof of Prerequisite/Co-Requisite Course Work (HCC130 and HCC145AA)
Copy of your High School Diploma, GED, or unofficial college transcripts
Completed and signed Health and Safety Documentation Form with copies of actual
immunization records or laboratory titer results as supporting documentation of:
o Proof of 2 MMR vaccinations or positive titer results for measles, mumps, AND rubella
o Proof of 2Varicella vaccinations or positive Varicella titer result (history of chickenpox is
NOT sufficient)
o Proof of 2 negative TB skin tests within the last year or negative chest x-ray within the
last year, dates must be valid throughout duration of program including clinicals
o Proof of 3 Hepatitis B vaccinations or positive titer result for Hepatitis B
o Proof of Tetanus (Td) vaccination within the last 10 years, dates must be valid
throughout duration of program including clinicals
o Health Declaration statement signed by M.D., D.O., N.P., P.A.
Current copy of CPR card for the Health Care Provider, through an American Heart Association
approved training program, dates must be valid throughout duration of program including
clinicals
Copy of current Level 1 Fingerprint Clearance Card, front and back, dates must be valid
throughout duration of program including clinicals
Clinical Planning Form (initialed)
*** Note: Materials turned in will not be returned to you and will be shredded***
I have completed this form and attached all of the required documentation listed above.
_____________________________________
Signature
_____________________________
Date
For Welcome Center Use Only:
Time and Date Stamp Required:
Hand-deliver all materials by 4pm THURSDAY, MAY 30, 2013 to the front desk staff of the Phoenix
College Welcome Center for application submission. Packets must be time/date stamped by staff.
Phoenix College Phlebotomy Program
Application Packet - FALL 2013
To be considered for either of the Fall evening programs, your application must be hand delivered to the
Welcome Center by 4pm on Thursday, May 30, 2013.
Name: _____________________________________________Date of Birth:_____________
Last
First
Middle
Former name(s) (Maiden) that may identify transcripts_______________________
Student ID Number:___________Telephone______________(hm)___________________(wk)/(cell)
Mailing Address
___________________________________________________________________
Street
City
State
Zip
Email: ________________________________________________________________________
I am applying for acceptance into the:
Fall 2013 August-October Evening Program
Fall 2013 September-November Evening Program
No Preference–Either Program Option
Have you applied previously?
If yes, please indicate date of initial application:________
Health Care/Work/Educational Experience
What is your current occupation:______________________________________________
Have you attended any other Phlebotomy Courses or Programs?
Yes
No
Are you enrolled in, or on a waitlist for, any other Health Education Program? Yes
No
If yes, Program Name and location:_________________________________________________
Education
Check each level of education you have completed.
GED
High School Diploma
AA Degree
Other _______
Prerequisite/Co-Requisite Course Work
1. Preference will be given to students who have completed the prerequisite/co-requisite coursework prior
to the application deadline. Students with courses in progress at the time of the application deadline will
be given second preference.
2. All courses must reflect a grade of “C” or better.
HCC130
HCC145AA
Course
Fundaments in Health Care
Delivery
Medical Terminology
Grade
College
Date Completed
In Progress(check)
Future Plans
**Statements will be evaluated for spelling and grammar, in addition to content**
Explain in at least 2-4 sentences, what role you intend the Phlebotomy Certificate of Completion to have in your
future career plans. Why do you want to pursue a Phlebotomy Certificate of Completion?
I certify that:
____
* (initial next to each item)*
It is my responsibility to provide all requested information to complete my file. Failure to provide all
requested information and requirements WILL adversely affect my admission into the program.
____ I understand that admission into the program is conditional until I have successfully completed all
requirements and submit any outstanding documentation to the program director, no later than August 1.
Failure to do so WILL result in removal from the program.
____
I understand that I will be required to submit to an additional background check after acceptance into the
program, no later than August 1, and that I am responsible for this expense. Failure to do so, or failure to
pass the additional background check, WILL result in removal from the program.
____
I understand that I will be required to submit to, and pass, a drug test after acceptance into the program,
prior to clinical externship, and that I am responsible for this expense.
____
I understand and agree to fully participate in classroom, laboratory, and clinical settings and program
activities.
____
The information provided in this application is true, correct, and complete to the best of my knowledge.
If any information changes (such as name, phone number, or address), it is my responsibility to notify
the Phlebotomy Program so the changes can be made in my file.
________________________________
_______________
Applicant Signature
Date
Phoenix College, one of the Maricopa Community Colleges, does not discriminate on a basis of race, color, gender, national origin, religion, handicap or age in
application, admission, participation, access and treatment of persons in instructional or employment programs and activities.
Application and materials will be reviewed and students notified by letter of their conditional acceptance or nonacceptance no later than the second week in July for the Fall Programs.
Hand-deliver all materials by 4pm THURSDAY, MAY 30, 2013 to the front desk staff of the Phoenix
College Welcome Center for application submission. Packets must be time/date stamped by staff.
Phlebotomy Program and Clinical Planning Form
In order to successfully complete the Phlebotomy program, you must choose one of the following
program options and clinical schedules, and you must initial that you understand the clinical schedule
you will be required to participate in.
Clinical hours must be completed during the dates/times listed, evening/weekend hours are not
available. However, the actual start times may vary and are determined by the individual clinical site.
**If your availability for clinical externship does not fall into one of these options, you will not be
able to be placed in a clinical externship, and will be removed from the Phlebotomy Program. **
_________________________________
Initial indicating you understand the above statement
Initial next to the Program Option and corresponding Clinical Externship Option that you wish
to be considered for acceptance into.
____________________________________________________________________________
August-October Evening Program
_______________
Initial indicating your preference
Classes (PLB109 and PLB111) run from August 20, 2013 – October 3, 2013, on Tuesday and
Thursday evenings from 5:00pm - 9:00pm.
Clinical externship (PLB122):
Mondays through Fridays between the hours of 7am and 5pm from October 7 through
October 25. Each student schedule will vary depending upon the dayshift hours of the clinical
site the student is placed in.
_____________________________________________________________________________
September-November Evening Program
_______________
Initial indicating your preference
Classes (PLB109 and PLB111) run from September 16, 2013 – October 30, 2013, on Monday
and Wednesday evenings from 5:00pm - 9:00pm.
Clinical externship (PLB122):
Mondays through Fridays between the hours of 7am and 5pm from November 4 through
November 22. Each student schedule will vary depending upon the dayshift hours of the clinical
site the student is placed in.
If you are Accepted Conditionally into the Phlebotomy Program:
There are new background check standards in effect for all Allied Health and Nursing Student in the Maricopa County Community College District (MCCCD). These changes are necessary due to the fact that six of eleven of MCCCD’s largest clinical experience hospital partners have established stringent background check standards that preclude MCCCD from assigning students to those sites who cannot meet those standards. In order for MCCCD students to be able to continue to complete clinical experiences at local hospitals, students must meet these new standards. In addition to the level 1 fingerprint clearance card, each student who is conditionally accepted into the phlebotomy program must provide documentation that he or she has completed and "passed" a MCCCD‐supplemental background check. Additional information will be provided to those students who are accepted conditionally into the program. Students are required to pay the cost of obtaining this supplemental background check. Full acceptance into the phlebotomy program will not occur until students submit and pass the MCCCD supplemental background check, which will have a due date of August 1st. Failure to submit to, and pass, the supplemental background check WILL result in removal from the program. Information regarding the supplemental background check will be mailed to you once you are conditionally accepted into the program. The cost of the supplemental background check is $67. In addition, each student who is conditionally accepted into the phlebotomy program is now required to sign an MCCCD Criminal Background Check Disclosure Acknowledgement form. This form will be sent to you once you are conditionally accepted into the program. This form MUST be signed and returned to the program director no later than August 1. Failure to submit the signed form WILL result in removal from the program. This is for your information only – no action is necessary unless or UNTIL you have been conditionally accepted into the program. MARICOPA COMMUNITY COLLEGE DISTRICT ALLIED HEALTH PROGRAMS
HEALTH AND SAFETY DOCUMENTATION
Student Name: ________________________________________
Date: ________________________________
Home Phone:__________________ Cell Phone:__________________
Student ID Number:_____________________
A.
MMR (Measles/Rubeola, Mumps, Rubella): Requires documented proof of two MMRs in lifetime or a positive titer for
each of these diseases.
1st MMR Date: _______________
2nd MMR Date: _______________
OR
Date and results of titer: Measles/Rubeola _____________ Mumps ______________ Rubella _____________
B.
Varicella (Chickenpox): Requires documented proof of two (2) vaccinations or positive IgG titer.
1st Varicella Date: ______________
2nd Varicella Date: ______________
OR
Date & results of IgG titer:___________________________________________
C.
Tetanus/Diphtheria (Td) immunization within the past 10 years.
D.
Tuberculosis:
Td Date: ____________________
Two-Step Testing** for initial skin testing of adults who will be retested periodically
TWO-STEP TESTING
Use two-step testing for initial skin testing of adults who will be retested periodically.
- If first test positive, consider the person infected.
- If first test negative, give second test 1-3 weeks later.
- If second test positive, consider person infected.
- If second test negative, consider person uninfected.
- If both parts of Two step test are negative then subsequent testing is done annually with one step procedure
INITIAL TEST:
Test Given_______________Date Read___________Result_____________________________
SECOND TEST (1-3 weeks after initial test):
Test Given:
Date Read: _________ Result_____________________________
OR
Annual TB skin test (PPD):
Test Given______________ Date Read___________Result_____________________________
OR
Previous Positive PPD test:
Provide documentation of negative chest x-ray/evidence of TB disease free status
Date of chest x-ray____________________Result____________________________________
*If applicant has ever had a positive reaction, the test is not to be repeated. Other evidence that the applicant is free from Tuberculosis will be
required.
**Core Curriculum on Tuberculosis What the Clinician Should Know, Department of Health and Human Services, Centers for Disease Control and
Prevention, National Center for HIV, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, Georgia, 4th Edition, 2000.
(continued)
MCCDAHealth & Safety Documentation rev 3/08
***Please attach documentation (test results, medical records,
etc)as proof for all immunizations to this Health and Safety
Documentation form***
MARICOPA COMMUNITY COLLEGE DISTRICT ALLIED HEALTH PROGRAMS
HEALTH AND SAFETY DOCUMENTATION
E. Hepatitis B: Documented evidence of completed series or positive antibody titer or declination. If beginning series, first
injection must be according to your Program’s required timeline and the series must be completed within 6 months.
Date of 1st injection: ___________ Date of 2nd injection: ___________ Date of 3rd injection: ____________
OR
Hep B Titer Date: _________________
Titer Results: _____________________________
OR
Signed Declination Form attached
F. Influenza: Documented evidence of influenza vaccination within the past year or declination.
Date of injection: ______________________________
OR
Signed Declination Form attached
G. Clearance for Participation in Clinical Practice
It is essential that allied health students be able to perform a number of physical activities in the clinical
portion of their programs. At a minimum, students will be required to lift patients and/or equipment, stand
for several hours at a time and perform bending activities. Students who have a chronic illness or condition
must be maintained on current treatment and be able to implement their assigned responsibilities. The
clinical allied health experience also places students under considerable mental and emotional stress as they
undertake responsibilities and duties impacting patients’ lives. Students must be able to demonstrate
rational and appropriate behavior under stressful conditions.
I believe the applicant __________ WILL OR __________ WILL NOT be able to function as an allied
health student as described above.
If not, explain: ________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Licensed Healthcare Provider (MD, DO, NP, or PA) Verification of Health and Safety
Print Name: _________________________________________ Title: __________________________________
Signature: ___________________________________________ Date: _________________________________
Address: ____________________________________________________________________________________
City: _______________________________________________ State: _________________________________
Telephone: _________________________________________
***Please attach documentation (test results, medical records, etc.)
as proof for all immunizations to this Health Documentation Form***
MCCDAHealth & Safety Documentation rev 3/08
MARICOPA COMMUNITY COLLEGE DISTRICT
ALLIED HEALTH PROGRAMS
EXHIBIT B
VACCINATION DECLINATION
(PRINT) Student Name_________________________
Date________________
(complete the sections that are appropriate for this student)
Hepatitis B Vaccination Declination
I understand that due to my exposure to blood or other potential infectious materials during the
clinical portion of my allied program, I may be at risk of acquiring Hepatitis B virus (HBV)
infection. The health requirements for the allied health program in which I am enrolled, as
described in the Student Handbook, include the Hepatitis B vaccination series as part of the
program’s requirements. I have been encouraged by the faculty to be vaccinated with Hepatitis
B vaccine; however, I decline the Hepatitis B Vaccination at this time. I understand that by
declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. By
signing this form, I agree to assume the risk of a potential exposure to Hepatitis B virus and hold
the Maricopa Community College Allied Health Program as well as all health care facilities I
attend as part of my clinical experiences harmless from liability in the event I contract the
Hepatitis B virus.
___________________________________
Student Signature
________________________
Date
___________________________________
Faculty Signature
________________________
Date
Influenza Vaccination Declination
I understand that due to the nature of health care and the volume of individuals that I may come
in contact with, I may be at risk of acquiring an influenza virus. The health requirements for the
allied health program in which I am enrolled, as described in the Student Handbook, include the
current influenza vaccination as identified by the Centers for Disease Control for the current
influenza season as part of the program’s requirements. I have been encouraged by the faculty to
be vaccinated; however, I decline the influenza vaccination at this time, I understand that by
declining this vaccine, I continue to be at risk of acquiring influenza. By signing this form, I
agree to assume the risk of potential exposure to influenza and hold the Maricopa Community
College Allied Health Program as well as all health care facilities I attend as part of my clinical
experiences harmless from liability in the event I contract the virus. I also understand that, due to
the contagious nature of the virus, that a health care setting may not accept my placement if I
refuse vaccination.
___________________________________
Student Signature
________________________
Date
___________________________________
Faculty Signature
________________________
Rev. 3/08 Vaccination Declination