Patient Preparation on the NHA CPT: Identification, Requisitions, Consent and Fasting

Most of what goes wrong with a blood test happens before the needle: the wrong patient, the wrong test, a patient who ate breakfast before a fasting draw. Patient Preparation on NHA's test plan covers that ground in 17 tasks (2A to 2Q) and 20 scored items, the highest ratio of tasks to items on the exam. Five tasks are new with the January 2026 exam, according to NHA's crosswalk: cultural sensitivity (2A), communication (2B), copayments and billing (2I), patient registration (2J) and EHR entries (2Q).

The NHA CPT patient preparation sequence

Registration and billing happen at check-in in settings where the phlebotomist also staffs the front desk, and not at all in many hospital draws. Checking an ID at the desk doesn't replace step 4: at the draw itself, introduce yourself and identify the patient with two identifiers before anything is collected. If a sequence question puts a front-desk task between the patient and the needle, identification still comes before the draw.

Throughout, tasks 2A and 2B ask for respect for diversity, cultural sensitivity and empathy, and effective communication with patients and colleagues. The test plan's knowledge statements spell out what that means: active listening, pace, tone and volume of voice, personal space, open-ended questions, and attention to language barriers, cognitive level, developmental stage, hearing impairment, and gender identity and pronoun use (k15 to k18, k40). With 17 tasks to cover, planned NHA CPT practice includes 260 Patient Preparation questions at launch.

Reading the requisition (task 2C)

Knowledge statement k42 lists the requisition fields a question can ask about: patient demographics, physician information, diagnosis code, tests ordered and test priority. Two related statements fill in the rest:

• Timing (k45). Draws can be STAT, routine, timed or tied to "high and low levels" or a time of day. Timing is part of the order, so a timed draw has to be collected at the time the order specifies.
• Coding (k44). The diagnosis code is usually ICD-10-CM, which CDC's National Center for Health Statistics describes as the system used to code and classify medical diagnoses in the United States. NCHS maintains the U.S. clinical modification.

Under CLIA, each lab must have written policies for patient preparation, specimen collection and labeling (42 CFR 493.1242), so the requisition and label rules you follow come from your lab's procedure manual.

Two identifiers before every NHA CPT draw (task 2E)

Knowledge statement k41 asks which "patient identifiers required for verification." The sources agree on the core rule:

• CDC: use at least two unique, patient-specific identifiers; CDC's blood culture quality tool gives the patient's name and date of birth as the example.
• WHO: ask the patient to state their full name, then check that the laboratory form matches the patient's identity. The WHO guidelines on drawing blood apply the same step to blood donors.
• Labels: Michigan Medicine Laboratories' collection guidelines say Joint Commission and College of American Pathologists rules require every specimen label to carry the patient's first and last name and a second identifier, such as birth date or medical record number, matching the requisition. A name or identifier discrepancy may get the test canceled.

Two exam habits follow. Ask an open question ("Please tell me your full name and date of birth") rather than one the patient can simply agree with ("Are you Ms. Lopez?"). And treat a room or bed number as a location, not an identifier: it isn't specific to the patient, and WHO's pediatric steps say outright not to use the bed number or a wristband attached to the bed or cot. Task 2E adds that identification follows HIPAA guidelines, which the NHA CPT safety and compliance guide explains.

Consent and guardian permission (tasks 2F and 2G)

The test plan lists three forms of consent, implied, informed and expressed, and asks for their components (k43). The sources give the essentials:

• WHO: discuss the test and obtain verbal consent. The patient "has a right to refuse a test at any time before the blood sampling," so make sure they understand the procedure.
• MedlinePlus: informed consent means the patient has received information, understands it and can decide. It can be written (a signed form) or given after a spoken explanation, and not every procedure requires written consent. Some blood tests, such as HIV or genetic testing, have required written consent, though MedlinePlus notes most states have dropped that requirement for HIV testing.
• NHA task 2G: when you can't get verbal or expressed consent, as with children or patients with dementia or mental disabilities, get permission from the legal guardian.

If the patient refuses, don't draw; follow your facility's procedure for reporting the refusal.

Insurance, copayments, registration and the EHR (tasks 2H, 2I, 2J, 2Q)

These are the front-desk tasks the 2026 plan added or split out. Task 2H asks you to confirm insurance coverage while reviewing the order; 2I to collect copayments and document billing "according to established protocol"; 2J to create new patient accounts and help with registration; and 2Q to make sure all pertinent information is in the EMR/EHR. Core Knowledge adds the systems behind them: EMR/EHR and scheduling software, computerized order entry and inventory (k20, k21).

What belongs in the record after a draw? WHO's list for a requisition and label includes the collection date, the patient's name and identity number, location, tests requested, number of tubes, collection method and the phlebotomist's initials. CDC's blood culture tool adds the volume collected, the body site, whether the sample came from a vein or a line, who drew it and where. Questions on these tasks usually test the protocol, so answer by the facility's procedure, not by convenience.

Fasting, medications and other test requirements (task 2K)

Task 2K asks you to verify that the patient followed the test's requirements "and proceed accordingly." MedlinePlus's fasting page sets out what fasting means:

• Nothing but plain water for several hours before the test, usually 8 to 12 hours; no juice, coffee, soda or flavored water.
• No chewing gum, smoking or exercise during the fast.
• Tests that usually require fasting include blood glucose tests, lipid panels and basic metabolic panels; some liver and kidney panels sometimes do.
• Medicines: the patient shouldn't stop taking prescribed medicines unless the provider says so.
• If the patient ate, they should tell the provider, and the test may need to be rescheduled.

A practical reading of "proceed accordingly" is to follow your facility's procedure when requirements weren't met, such as notifying the ordering provider or the lab, rather than drawing and saying nothing. Tolerance tests, which start with a fasting draw, are in the NHA CPT special collections guide. For recall of requirements like these, 90 Patient Preparation flashcards are planned for NHA CPT prep.

Interviewing for allergies, fainting and special considerations (task 2L)

WHO's preparation step is to ask whether the patient has allergies, phobias or has ever fainted during previous injections or blood draws, and to reassure an anxious patient and ask what would make them more comfortable. The test plan lists what else changes a collection:

• Variables (k48): allergies, medications, recent surgeries and history of fainting
• Special considerations (k49): age, physical and mental condition, and the presence of fistulas

Each answer changes something: a history of fainting means positioning the patient lying down, a dialysis fistula rules out that arm, and an anticoagulant means watching for prolonged bleeding. Those responses are in the venipuncture guide.

Positioning the patient (task 2N)

WHO's advice is to make the patient comfortable in a supine position if possible, with the arm extended, and to have a patient lie down if they express concern about fainting. For a child having a capillary sample, WHO describes the parent seated with the child on their lap, holding the child's free arm, elbow and wrist. Task 2N's three goals, comfort, safety and a good specimen, are the test for any answer option: a position that risks a fall or a bent arm fails two of them.

Instructions for urine, stool, semen and sputum samples (task 2P)

Two Passy examples on patient preparation

These are original Passy practice items, not NHA questions.

Example 1: identifying an inpatient

A phlebotomist arrives at room 412 for a STAT draw. The patient is awake and alert. Which identification meets the two-identifier rule?

• A. Ask her to state her full name and date of birth, then match the requisition
• B. Confirm the room and bed number on the door, then match the requisition
• C. Ask "Are you Maria Lopez?" and match the answer to the name on the order
• D. Ask the nurse which patient is in the bed, then match the requisition

Answer: A. CDC calls for at least two unique, patient-specific identifiers, such as name and date of birth, and WHO asks the patient to state their full name. A room number (B) is a location, a yes-or-no question (C) gives one weak identifier, and D skips the patient entirely.

Example 2: a fasting patient who had coffee

An outpatient with an order for a fasting lipid panel says she had coffee with cream an hour ago. What should the phlebotomist do?

• A. Follow the facility procedure: notify the provider or lab before drawing
• B. Draw the specimen and write nothing, since coffee is mostly water
• C. Draw now and ask the lab to lower the reference range for her
• D. Tell her to drink water for an hour, then draw her as fasting

Answer: A. MedlinePlus says coffee breaks a fast and that the test may need to be rescheduled, and task 2K asks you to verify compliance and "proceed accordingly." B and D treat a broken fast as valid, and C isn't something a phlebotomist can arrange.

Patient Preparation rewards steady, task-by-task review, and planned AI Rescue can quiz you with a fresh NHA CPT practice question on any explanation you open.

Your next step for NHA CPT patient preparation

Walk through the ten-step table with a friend playing the patient, including one who refuses and one who ate breakfast. Then check the domain's other tasks in the NHA CPT test plan guide and try the 20 free NHA phlebotomy practice questions.