What is the NCCT?

The National Center for Competency Testing (NCCT) is the credentialing organization responsible for testing and certifying professional healthcare roles. After training from an accredited program is completed, an exam is administered and must be passed to become a certified phlebotomy technician (CPT). Here’s everything you need to know about the NCCT and the NCPT.

Theranos Case Study: Where the Line Was Crossed

By now, you’ve likely heard of the Theranos incident involving Elizabeth Holmes. It goes down as one of the all-time failures in the phlebotomy technology industry. It wasn’t all that long ago that Holmes, the founder of Theranos, appeared on covers of Time Magazine, showcased as one of the most promising business icons of this generation. The tables have turned, however—let’s take a look.

A Brief Overview

Theranos was a health technology corporation considered as the “next big thing” in the realm of blood testing. It was founded in 2003 by Elizabeth Holmes, who was only 19 years old at the time. The selling point of Theranos’ blood collection technology was that it only required 1/100 to 1/1000 of the blood amount that would normally be required for testing. The operating costs of this new testing system was considerably lower than traditional methods. Theranos received a $10 billion valuation by 2013, partially due to Holmes raising more than $700 million in venture capital. Hence, partnerships were formed with Safeway, Walgreens, the Cleveland Clinic, and more.

Elizabeth Holmes

Elizabeth Holmes, the founder of Theranos, was born in Washington D.C. Her family had connections in business and politics, as her father was a vice president at Enron, and her mother was a Congressional committee staffer. In 2004, Holmes dropped out of Stanford and used the unallocated tuition funding to start a consumer healthcare technology company. This company was called “Real-Time Cures” and had the mission of democratizing healthcare. Holmes claimed that her fear of needles was motivation to create a blood test that only requires a small amount of blood from the tip of a finger. Her company was incorporated as “Theranos” in April of 2004.

The Downfall

Everything started to go downhill as of October 2015 when John Carreyrou, a reporter from The Wall Street Journal, publicly challenged the credibility of Theranos’ technology. He was tipped off by ex-Theranos-employee, Tyler Shultz. Carreyrou then reported that instead of using their patented Edison devices to run blood tests, Theranos was merely using traditional blood testing machines. Carreyrou argued that Theranos’ Edison machines may not be reporting accurate blood test results. This led to a surplus of legal and commercial challenges from medical authorities, outraged investors, the SEC, the CMS, state attorneys general, and patients reliant on Theranos’ technology.

Everything continued to unravel from here. Walgreens put its plans to expand blood-testing centers in all stores on pause. The Cleveland Clinic created an investigation, working to verify if Theranos technology actually served its purpose. Formal FDA inspections were conducted, and Theranos’ technology failed many components of the tests. At this point, Theranos announced it would suspend its testing voluntarily.

Crossing the Line

John Carreyrou proclaimed the Theranos incident as “one of the most epic failures in corporate governance in the annals of American capitalism.” Many people believe that the somewhat shady culture of Silicon Valley led to the fraudulent business taking shape. The “win at all cost” and “fake it until you make it” ideologies helped many entrepreneurs become successful in the valley, but Theranos taught us that these same mantras should not be applied to the medical field where human lives are at stake.

The lack of accountability also played a role. The board of Theranos and federal regulators did not oversee operations to an acceptable extent. Furthermore, potential whistleblowers were met with threats of lawsuits. This toxic culture was purely unsustainable. False representation is a serious offense in business, and in the medical industry, it is purely unacceptable. Holmes falsely represented her technology to all kinds of stakeholders including investors, doctors, and patients.

Justice is bringing Holmes and Theranos back down to earth. Currently, Holmes and former chief operating officer and president Ramesh Balwani are facing criminal charges. They have pleaded not guilty, but potentially face 20 years in prison. Let this entire situation be a lesson that Silicon Valley startups led by seemingly invincible leadership are often more fragile than they seem. Carreyrou exclaims, “When you enter industries where lives are in the balance, you can’t really just iterate and debug as you’re going. You have to get your product working first.” If you have any questions about Theranos, blood withdrawal, or phlebotomy training, feel free to contact PhlebotomyU today.

Summer Phlebotomy Courses are Easier Than You Think

Have you considered taking a phlebotomy course over the Summer? Many people think about it but are then intimidated by the perceived commitment it takes to go through a course and achieve NCCT phlebotomy certification. Did you know that a phlebotomy course could fill just one-third of your Summer? Let’s explore why Summer phlebotomy courses are easier than most people think.

How Easy are Summer Phlebotomy Courses?

First, let’s go over the prerequisites for taking Summer phlebotomy courses. Before you enroll in a CPT1 phlebotomy certification course, you must meet several requirements. You must be a high school graduate or have a GED, and you must be able to pass a basic reading comprehension test. Students are typically subjected to a basic background check and drug screen as well. All in all, eligibility for Summer phlebotomy courses isn’t very complicated.

Students actively participate in lectures, labs, and clinical settings in order to attain the knowledge and skills necessary to take and pass the national exam. Here are some basic phlebotomy principles that will be emphasized:

  • Blood withdrawal from veins
  • Order of draw
  • Anatomy and physiology
  • Post-puncture care
  • Anti-contamination practices
  • Saf bio-hazard techniques

What is the Time and Effort Commitment?

 Summer Phlebotomy courses can be completed in as little as one month. Here is the breakdown of common Summer phlebotomy course hours:

  • Basic didactic phlebotomy training: 20 hours
  • Advanced didactic phlebotomy training: 20 hours
  • Interactive classroom phlebotomy training: 40-60 hours

A clinical externship is part of most Summer phlebotomy courses. Externships can last from 40 to 120 hours in a partnering clinic or hospital. After you’ve completed your hours and externship experience, then it’s time to take the NCCT phlebotomy exam. This test consists of 145 questions covering six main categories. Good news–while official NCCT certification is a highly esteemed accolade, it isn’t too hard to attain. The most recently reported passing rate was over 75% for first-time exam takers.

Where and When to Take Phlebotomy Courses Over Summer

Are you ready to earn national certification and jump into your phlebotomy career? PhlebotomyU offers the following 2019 Summer phlebotomy courses.

summer phlebotomy courses

PhlebotomyU Offers an Ideal Summer Phlebotomy Course

Hopefully we’ve provided enough evidence that Summer phlebotomy courses are not as difficult an undertaking as one might initially think. One month at PhlebotomyU is all it takes to attain NCCT certification. (plus your willingness to learn) Have questions regarding courses? Feel free to contact us. We hope to see you in the classroom this summer!

Phlebotomy Externship FAQ

Considering pursuing a career in phlebotomy? You will likely partake in a phlebotomy externship before receiving official certification. Many people are unsure what exactly a phlebotomy externship entails. Let’s take a look at some frequently asked questions.

What is a phlebotomy externship?

A phlebotomy externship is an opportunity to use your knowledge gained from a phlebotomy education program, and put it to practical use.

Do I get paid?

Phlebotomy externships are typically unpaid. The hands-on experience you will obtain is extremely valuable however, as it provides you a chance to work under the guidance of seasoned phlebotomy professionals.

Is completing a phlebotomy externship required for certification?

A clinical phlebotomy externship is required in the state of California. Although, most other states do not require completion of a clinical externship.

Where are phlebotomy externships done?

Externships are usually undertaken in hospitals or clinics affiliated with your phlebotomy training program. This can vary due to what clinical facilities are located around your specific phlebotomy training program.

How long is the externship experience?

Generally, phlebotomy externships are between 40 and 120 hours. On average, these hours are dispersed over the course of four weeks.

Can I pick where I complete my externship?

Phlebotomy training programs typically assign externs to designated locations. Don’t fret, most externship facilities are credible and prepare you for your career in phlebotomy—this is emphasized at PhlebotomyU.

Is attendance and punctuality important?

Try your best to show up every day of the externship. Treat it like a real job. You will surely have to make up any days or hours missed. Attendance and punctuality are vitally important for both externships, and full-time phlebotomy jobs.

Is there usually a dress code?

Phlebotomy externships typically require a dress code. Hair past the shoulders should be pulled back. Sweat pants, joggers, and torn pants are generally not allowed. Tops and shirts should not be fluorescently colored, denim, or transparent. Closed-toed shoes are strictly required. Fingernails must be trimmed, and no artificial nails are allowed. Finally, avoid wearing perfume or cologne, as it could cause an allergic reaction to patients or fellow externs.

Will I work with actual patients?

Indeed, you will. Along with other healthcare professionals, you will have the opportunity to treat actual patients under supervision. After a bit of training, you will be tasked with drawing blood out of real patients. Keep in mind, that mistakes will be made—even phlebotomy technicians with years of experience can miss the vein. Many patients come in dehydrated, therefore making it difficult to puncture a vein, as well.

Will a phlebotomy externship directly lead to a job?

You never know—but if you show enthusiasm to learn, and execute your phlebotomy skills effectively, then there is a good chance you will receive a phlebotomy job offer by the end of your externship experience. At the very least, you may be able to obtain a strong letter of recommendation from your supervisor.

Which educational phlebotomy program should I choose?

Your ideal phlebotomy career is awaiting you. After attending PhlebotomyU, and completing an externship, you can obtain your CDPH-approved Phlebotomy certificate. PhlebotomyU takes pride in training and preparing students with the necessary skills required to succeed throughout their Phlebotomy training experience, and beyond. Career services help students get externships, and full-time jobs after becoming certified. Have questions regarding phlebotomy externships? Don’t hesitate to contact us with any questions.

Is Education for Phlebotomist Jobs Worth it?

The BLS estimates that phlebotomy positions will increase by 25% between 2014 and 2024. An increase of 28,100 phlebotomy jobs shows much more growth than the average US job market. Phlebotomy technician salaries are also increasing. Are you interested in becoming a phlebotomist, but unsure about the educational requirements? Let’s take a look at whether or not education is worth it to enter the field of phlebotomy.

What is Phlebotomy Education?

A phlebotomy education is typically undertaken in order to attain a CPT1 certification. This is commonly done through the NCCT—an accredited testing organization. National certification is not technically “required,” but it is extremely helpful and almost essential in obtaining employment as a phlebotomist.

Many degree-based schools such as community colleges will hold phlebotomy certificate programs that can either work with a 2-year or 4-year program or as a stand-alone certificate. These classes are commonly offered in a unit-based format ranging between 6 and 10 unit hours over the course of an academic semester. Medical Vocational Schools offer phlebotomy training programs as well, some in similar unit-based formats.

Many training programs offer hands-on classroom training that allows you to attain your CPT1 certification in 5 weeks. PhlebotomyU, for example, is a 5-week course that includes 20 hours of basic didactic training, 20 hours of advanced didactic training, 40-60 hours of hands-on classroom training, and 40-120 externship hours with a partnering clinic or hospital.

Pros of Getting a Phlebotomy Education

  • Certification is required in a few states, so you may have to take the certification test, regardless. To pass this test you will need to enroll in a program specializing in education for phlebotomists. California is one of the few states that requires “all persons who are not doctors, nurses or clinical lab scientists” to have a current license, to participate in blood withdrawal.
  • Because going through the process of phlebotomy training is fairly simple, (compared to other medical fields) more and more people are becoming educated and certified. This means that there is more competition in the phlebotomy job market, highly favoring those who have taken the time to train and become certified.
  • There is a large potential for advancement once you receive a phlebotomy education. Many certified phlebotomists decide to advance to careers such as medical assistants, surgical technologists, neurodiagnostic technologists and other highly advanced occupations.

Cons of Getting a Phlebotomy Education

  • Many phlebotomy educational institutions only offer programs that take more than six months to become certified. Most people are unwilling to wait this long to start earning a salary. The costs of these longer-duration programs tend to be higher, as well.
  • Numerous phlebotomy education programs charge over $4000 for a CPT1 course, and many do not include course materials and lab supplies in these costs.
  • There is a barrier to participating in phlebotomy training programs. One must have a high school diploma or GED in order to apply and take the certification test.

The Phlebotomy Education Verdict

Hence, is education for phlebotomist jobs really worth it? If you intend to become a phlebotomist, then we strongly encourage you to partake in a phlebotomy educational program. The pros simply outweigh the cons. Courses are available in California for becoming a Limited Phlebotomy Technician, Certified Phlebotomy Technician I, and Certified Phlebotomy Technician II. An LPT is only permitted to perform skin puncture and blood collection. A CPT I can perform venipuncture. A CPT II can perform arterial puncture. Choose which phlebotomy course you take depending on the license you wish to pursue.

PhlebotomyU offers a CPT1 Full Course which includes nearly everything you need to get nationally certified and apply for your California phlebotomy license. The competitive price of $2,900 includes a clinical externship as well.

How to Attain Education for Phlebotomist Jobs

Your ideal phlebotomy career is waiting for you. If you want to be successful in the field, a proper phlebotomy education is essentially a prerequisite. After attending PhlebotomyU, you can obtain a CDPH-approved Phlebotomy certificate. PhlebotomyU prides itself in training and preparing students with the necessary skills required to succeed throughout their Phlebotomy career. Valuable assets offered include readily available career services, and a hands-on phlebotomy internship. Still weighing the benefits and drawbacks of pursuing a phlebotomy education? We’d be happy to talk—contact us with any questions.

Basic Phlebotomy Principles

If you are considering entering the field of phlebotomy, it is a good idea to learn about the underlying phlebotomy principles first. We will provide a brief overview of infection control, anatomy and physiology, puncture site selection and preparation, order of draw, and post-puncture care.

Basic Infection Control

Standard operating procedures must be followed when it comes to infection control and quality assurance. These steps should be made available to phlebotomists in a clinical environment. To effectively control and prevent infections, proper hygiene-materials must be used. Here is a list of hygienic materials to be kept in a medical environment conducting phlebotomy:

  • Soap
  • Water
  • Alcohol rub
  • Non-sterile gloves
  • Single-use disposable needles
  • Syringes/lancing devices

In the same sense, contaminated phlebotomy equipment must be discarded in an appropriate manner. Did you know that up to 25% of tourniquets are contaminated through inadequate hand-hygiene? Also, hepatitis B has been known to spread through reusing finger-prick devices. Needles, syringes, and blood sampling devices should be disposed into a puncture-resistant sharps container, in order to uphold proper phlebotomy safety standards. It is important to know which pieces of equipment can be reused, versus what should be discarded.

Basic Anatomy and Physiology

Knowledge of anatomy and physiology is one of the most crucial phlebotomy principles. Anatomy is the study of body structure, and physiology is the study of body function. This topic as it relates to phlebotomy is a major focus in phlebotomy schools—an understanding of the basics is required to be a successful phlebotomy technician.

Proper Selection and Preparation of Skin Puncture Site

Site selection can make or break a phlebotomy procedure. Generally, you want to examine a patient’s extended forearm. Locate a sizable vein that is visible, straight and clear. A good place to start is the median cubital vein, because it is the easiest to puncture successfully. It is wise to avoid the basilic vein, in order to negate the possibility of damaging the nerve or artery. It is also a considerably more painful blood withdrawal. Vein diversions should also be avoided, to decrease the chance of a hematoma.

It is important to disinfect the entry site before puncturing. Clean the site with a 70% alcohol (not povidone iodine) swab for 30 seconds while applying a gentle pressure. Allow some time for the site to dry. This decreases the contamination risks. After the site is cleaned, it is imperative that you do not touch the site with your finger, as this will commonly result in an infection.

Order of Draw      

Blood must be collected in tubes in a very specific order. This phlebotomy principle is referred to as “Order of Draw.” It can be somewhat difficult to remember. Here are the 9 elements of order of draw:

  1. Color varies-blood cultures
  2. Light blue-sodium citrate
  3. Red-clot activator
  4. Gold-SST
  5. Light green-lithium heparin
  6. Dark green-sodium heparin
  7. Lavender-EDTA
  8. Gray-Sodium Fluoride
  9. Yellow-ACD Solution

A helpful way of remembering the color order is, “Boys Love Ravishing Girls Like Dieters Love Greek Yogurt.” (blood culture, light blue, red, gold, light green, dark green, lavender, gray, yellow) Make sure to verify that your laboratory is using the same colors and descriptions.

Post-Puncture Care

After blood withdrawal has occurred, a major phlebotomy principle is cleaning contaminated surfaces and completing interactions with the patient. Double checking the phlebotomy labels and forms helps to ensure accurate standards of information. Hand hygiene should be performed once again, to protect against infections. Check if the patient is feeling satisfactory. Then, make sure that the needle insertion site is not bleeding. Once these final post-operation steps are taken, the patient is free to leave. The next step is to prepare and transport blood samples—this process is an educational focus of certified phlebotomy training programs.

Master Phlebotomy Principles at PhlebotomyU

This guide acts as a basic introduction to the principles of phlebotomy; it alone does not adequately prepare you to be a certified phlebotomist. PhlebotomyU on the other hand, has the sole purpose of educating individuals on the most up-to-date trends in blood analysis, venipuncture, and everything else related to phlebotomy. Basic and advanced phlebotomy principles will be covered in-depth. Interested in becoming a certified phlebotomist and entering a highly in-demand workforce? Contact us today, for more information on pursuing your CDLH-approved phlebotomy license.

What does Venipuncture Mean?

If you are familiar with medical terminology, then you’ve likely heard of “venipuncture.” It plays a key role in the world of phlebotomy. Let’s take a closer look at what venipuncture truly means, the basic steps in the venipuncture process, common venipuncture equipment, and the various withdrawal sites.

Defining venipuncture

What is venipuncture? It is the collection of blood from veins. It is most often performed for the purpose of laboratory testing. It is done with a needle, and typically performed by a phlebotomist. Venipuncture may also be performed in order to remove extra red blood cells from the blood, to treat various blood disorders. There are many factors at play during a venipuncture procedure. For example, “Order of Draw” is a vital concept to understand, for the purpose of avoiding cross-contamination of additives between tubes. Venipuncture is actually one of the most routinely performed invasive procedures. There are five primary reasons for performing a venipuncture:

  1. Obtaining blood for diagnostic purposes
  2. Monitoring levels of blood components
  3. Administering therapeutic treatments (medications, nutrition, chemotherapy)
  4. Removing blood due to excess levels of iron or erythrocytes (red blood cells)
  5. Collecting blood for later uses (transfusion in the donor)

Steps in the venipuncture process

Here is our master list of steps to practicing venipuncture successfully. In a phlebotomy course, these steps will be broken down and taught with hands-on training by professional educators.

1. Review the order of draw

2. Gather the supply tray and cart

3. Approach, identify, and prepare the patient for the process

4. Maintain proper hand-hygiene

5. Apply the tourniquet, ask the patient to make a fist, and assess the antecubital space

6. Select a vein, release the tourniquet, and ask the patient to relax their fist

7. Cleanse the site thoroughly

8. Put on clean gloves and prepare your equipment

9. Reapply the tourniquet, have the patient make a fist, and uncap the needle

10. Properly anchor the vein and insert the needle

11. Establish blood flow and have the patient open his or her fist, then release the tourniquet

12. Fill tubes using the correct order of draw and mix tubes

13. Place gauze, remove the needle, and apply appropriate pressure to the site

14. Discard the collection unit

15. Label the tubes

16. Implement special handling techniques

17. Check and inspect the patient’s arm, then apply a bandage

18. Dispose of the materials and clean up

19. Remove your gloves, perform hand hygiene techniques, and thank the patient

20. Securely transport specimens to the lab for testing

Venipuncture Equipment

The equipment used during the venipuncture test can vary, but the following are most commonly used for routine venipuncture:

  • Collection tubes
  • Needles
  • Tourniquet
  • Wipes/Swabs
  • Gauze
  • Bandages
  • Gloves
  • Disposal unit

Venipuncture Sites

Phlebotomists do not always draw blood from the same area and site in the human body. Venipuncture is most commonly performed on the Antecubital Fossa, which is the inside of the elbow. In this region, phlebotomists will usually decide between three veins including the median cubital vein, the cephalic vein, and the basilic vein. If all of these veins in the inside elbow area do not look promising, then the phlebotomy technician may choose a dorsal vein in the hand or worst case, a vein in the foot. Semi-common problems include improper blood flow from the vein, which causes phlebotomists to switch sites.

PhlebotomyU offers venipuncture courses

Our CPT1 5-week course emphasizes proper venipuncture training. An on-site sitting of the NCCT National Phlebotomy Certification Exam is included with the training program. Furthermore, certified radiologic technicians in California are require to take a 10-hour safe venipuncture training course in order to safely perform venipuncture for administering contrast x-rays. We have created a didactic course that allows radiologic technicians to safely and legally perform venipuncture in California. Still wondering about the topic of “what does venipuncture mean?” Or are you considering enrolling in a phlebotomy class with PhlebotomyU and have questions? Don’t hesitate to contact us today.

What are the Phlebotomist Certification Requirements?

Interested in becoming a certified phlebotomist? There are various requirements, depending on the state you plan on practicing in. This article will focus on the state of California. Let’s take a look at phlebotomist certification, training and certifying programs, and requirements for all three license types.

About Phlebotomist Certification

Phlebotomy certification is a state required standard—it is not on a single national scale. In order to become a phlebotomist in California, it is highly recommended that you fulfill CA phlebotomist certification requirements. What does this mean? Essentially, you must complete a phlebotomy training program, and then pass a phlebotomy exam.

Phlebotomy Training Programs and Requirements

There are usually program requisites for phlebotomy schools. Most phlebotomy programs require that you have a copy of your high school diploma or General Education Diploma. Background checks are a common requirement to be accepted as a phlebotomy student. Here is a list of further general requirements:

  •  Students must be a minimum of 18 years old
  • Students must hold a current American Heart Association BLS CPR card
  • Students must have proof of a negative Tuberculosis skin test or negative chest x-ray administered within three months prior to the first class
  •  Students must have proof of a current Mumps, Measles, & Rubella (MMR) and Varicella immunization
  •  Students must have proof of a Hepatitis B vaccination
  •  Students must have access to a background report and professional liability insurance
  •  Students must bring a physical exam, showing that the student is fit enough to work
  •  Students are required to possess two official sealed transcripts for admission

Once accepted, students will typically receive classroom lectures, lab training, and hands-on clinical experience. Subjects covered will range from basic anatomy, to advanced venipuncture. Non-medical techniques are also worked on in these training programs. This could include psychology, communication skills, and technology optimization. Many institutes have a phlebotomist certification requirement of participating in an externship or practicum, with an emphasis on supervised field experience.

Certifying Organizations

Completing your phlebotomy course does not mean you’ve checked off all of the certification boxes. It is still a requirement to take the National Phlebotomy Certification Examination (conducted by the NCCT). Many Phlebotomy training programs allow you to take the exam on-site. Training programs are usually not technically required to take a competency exam; however, there is typically a minimum experience level for these said test-takers. All in all, taking a phlebotomy class is the most recommended course of action for those seeking to take the NCCT National Phlebotomy Certification Exam.

The various NCCT exam fees can be found here:

https://www.ncctinc.com/Documents/Examination%20Fees.pdf

Phlebotomy Certification Requirements for the 3 License Types

How do you know which license certification to pursue? Limited Phlebotomy Technicians are only authorized to collect skin puncture blood samples. A Phlebotomy Technician I license grants permission to perform venipunctures as well as skin punctures. A Phlebotomy Technician II license grants authorization to perform venipuncture, arterial punctures, and skin punctures.

Phlebotomy Technician 1 licenses have several requirements, which are essentially identical to the Limited Phlebotomy Technician license requirements. (A few extra requirements are necessary) Phlebotomy license requirements for this certification include the completion of at least 40 hours of didactic training through a CDPH-approved program. 40 hours must also be completed in a supervised practical training—10 skin punctures and 50 venipunctures are also required to be performed under professional supervision in clinical training.

Regarding the Phlebotomy Technician II license, the main difference is that you must already have a current CDPH Phlebotomy Technician I license, along with 1040 hours of field-experience throughout the past five years. You must have completed 20 arterial punctures, as well. a CDPH-approved practitioner to write a letter for you, containing proof of these punctures.

Fulfill Phlebotomist Certification Requirements at PhlebotomyU

Your dream phlebotomy career is ready for you. After attending PhlebotomyU, you can achieve your CDPH-approved Phlebotomy certificate. PhlebotomyU prides itself in training and preparing students with the necessary skills required to succeed throughout their Phlebotomy career. Valuable assets offered include readily available career services, and a hands-on phlebotomy internship. Have questions regarding phlebotomy license requirements? Please don’t hesitate to contact us with any questions.

CDPH Laboratory Field Services Overview

The LFS is made up of 5 sections, including Laboratory Licensing and Registration, Personnel Licensing, Clinical Laboratory Improvement Amendment, On-Site Licensing, and Blood and Tissue Bank Licensing and Cytology Surveillance. Let’s take a look at these divisions and the LFS organization as a whole.

State of California Phlebotomy License Requirements

The state of California requires that all Phlebotomy Technicians or Phlebotomists who work in California hold a current California Phlebotomy License. There are various phlebotomy license requirements that must be met before and while holding a license. We shall delve into what is required for different license applications, and how to keep your license valid after successfully achieving certification.