There are multiple types of office visits, all of which are named by the specific medical office. Some may have similar names but all have either unique care given or unique billing circumstances differentiating them. When working in a General Practitioner’s or in a Family Medicine office there are some main appointment types to become familiar with including: New Patient/Establish Care or Re-establish Care, ER Follow-ups, Physical Exams, Medicare Wellness, Well Child, Worker’s Compensation, Department of Transportation (DOT) Physicals, New Pregnancy, Musculoskeletal New Problem/injury, and Blood Draws. Each type of visit usually has a specific amount of time allotted and, based on provider preference, a maximum number of appointment types allowed per day. We will review the Phlebotomist's role during each appointment type, as well as the tests commonly done and tubes used.
New Patient/Establish Care appointments
New Patient/Establish Care appointments are typically scheduled for patients the office has not yet seen, whether the patient is a newborn, child, or adult. There are times at these appointments when blood will need to be drawn. There are a few different blood tests that the provider could consider for baselines or for routine wellness checks. The blood tests that are commonly ordered for adults are: a Complete Blood Count or CBC, which is commonly drawn in a lavender top tube; B-type natriuretic peptide or BNP, which is commonly done in either a lavender or pink top EDTA tube; Thyroid panel, which is commonly done in either a red or gold topped tube; Lipid Panel which is commonly drawn in a Serum separator tube or SST tube, Hemoglobin A1C which is drawn in a Lavender topped EDTA tube, and sometimes Enzyme Markers tests which are drawn in a red topped tube.1 Newborn blood tests are a bit different than adults, as they are commonly done via heel stick procedure. Some blood tests that are commonly completed for newborns are PKUs, in which a tube isn't commonly used (unless necessary); instead, the use of monofilament paper for the blood test is common. Another test that can be commonly requested during newborn new patient appointments is bilirubin, which is commonly drawn in an amber vial via heel poke due to light sensitivity.1
Re-establish Care
Appointments to Re-establish Care are for patients who have previously been seen in the office but it has been more than three years since their last appointment. Often times during reestablish care appointments, blood screening tests are ordered in similar occurrence as with what is usually drawn at a new patient or Wellness check-up. An exception may be that in prior care, the patient may have been undergoing specific treatment or monitoring a condition to which resuming that care with updated values is necessary. An example may be someone with a history of pre-diabetes or hypothyroidism. In order to resume care, a provider will want up to date values on blood glucose via a Hemoglobin A1C or a TSH (or Thyroid panel) respectively. Commonly ordered and/or routine lab tests at a re-establish care appointment for adults are: a CBC, which is often drawn in a lavender top tube; a BNP, drawn in either a lavender or pink top EDTA tube; a Thyroid panel, drawn in either a red or gold topped tube; a Lipid Panel, drawn in a Serum separator tube or SST tube; a Hemoglobin A1C, drawn in a Lavender topped EDTA tube; and lastly, sometimes Enzyme markers tests which are drawn in a red topped tube.1
New Pregnancy
New pregnancy appointments typically occur between the 6th and 12th weeks of pregnancy calculated from the patient's last menstrual cycle.1 At these visits, it is very common to get lab testing completed to see the patient’s baseline for conditions that can become problematic during or complicate pregnancy and to catch any issues early on. The blood tests that are commonly ordered at new pregnancy appointments are: a CBC, drawn in a lavender top tube; a Blood Type and Antibody Screen, drawn in a pink top EDTA tube; Prenatal Panel, which are collected in a variety of tubes including lavender-top, pink-top EDTA tube, red-top, or serum separator (SST) tubes depending on the panel; next is the first trimester screenings which is most commonly collected in a Lavender-top tube; an AFP screening, commonly drawn in a red-topped tube; and lastly the Quad screening which is also drawn in a red-toped tube.1 Urine samples are frequently collected during these appointments testing for both the presence of bacteria and for recreational drug use. In order to test a urine sample for both tests, a clean catch sample must be collected.
Physical Exam Visits
Physical Exam appointments happen yearly; this type of appointment is for the provider to assess the patient’s overall health, address the patient's concerns, complete any age-related screening tests, administer any needed immunizations, and collect blood work, as appropriate. At this appointment or before this appointment, the provider will likely order the following blood tests, including but not limited to: a CBC, drawn in a lavender top tube; a Thyroid panel, drawn in either a red or gold topped tube; a Hemoglobin A1C, drawn in a Lavender topped EDTA tube; a CMP, drawn in a Serum Separator tube; Vitamin D, drawn in a Serum Separator tube; and lastly, PSA which is drawn in a red-topped tube.1
Medicare Wellness Visits
Medicare Wellness appointments are for patients who have Medicare insurance. During a Medicare appointment, the provider will assess the patient’s health, perform any necessary age-related screenings (cancer, depression, etc.), and monitor the patient's health risks. Just as done in a regular physical exam visit, at medicare wellness visits, labs are ordered at this appointment or before this appointment. The provider will likely order the blood tests including but not limited to: a CBC, drawn in a lavender top tube; a Thyroid panel, drawn in either a red or gold topped tube; a Hemoglobin A1C, which is drawn in a Lavender topped EDTA tube; a CMP drawn in a Serum Separator tube; a Vitamin D, drawn in a Serum Separator tube; and lastly, a PSA which is drawn in a red-topped tube.1 Remember, each individual person is different; some may need more or other testing depending on their individual health needs.
Well Child Visits
Well-child appointments are for children from birth to 18 years of age. During a well-child exam, the provider will assess the child’s overall health and address any questions from the child, parent, or guardian. At this time, if needed, sports physicals can also be completed for the child. Blood draws at well-child visits are less likely, but when they are ordered, the tests requested are most commonly Lead levels, which is done in either a tan or royal blue tube or an Iron level, which is most commonly collected in a red-topped tube.1
Musculoskeletal New Problem/Injury
Musculoskeletal New Problem/Injury appointments, sometimes called Orthopedic New problem/injury appointments, are for patients with issues or injuries to their musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.3 Some tests that may be ordered at this appointment type may include ESR, which is commonly drawn in a lavender top tube; C-reactive protein or CRP, commonly drawn in a Serum separator tube or SST tube; and a Creatine Kinase or (CK), which is drawn in either a red topped or green topped tube.1
ER Follow-up Visits
Hospital/ER follow-ups are appointments after a patient is in the hospital, whether for a procedure, surgery, or emergency. When the patient is leaving the hospital, their discharge summary gives instruction to follow up with a specialist or primary care provider within a certain amount of time. Some tests that may be ordered include but are not limited to: a CBC, drawn in a lavender top tube; a BNP, which is often collected in either a lavender or pink top EDTA tube; a CMP, drawn in a Serum Separator tube; a Troponin, often drawn in a green top tube; a D-Dimer, which is collected in a light blue topped tube; an Arterial Blood Gas or ABG, which is drawn in a Green top tube(note, this test is an arterial puncture specimen collection thus has limitations on who can collect it, namely an RN, RT, CPT-II or a physician); and lastly, Blood Cultures, which are collected in a set specific blood culture bottles that are typically yellow-topped tubes.1
Worker’s Compensation Visits
Worker’s Compensation appointments are for patients who have an accident at work and need to have an appointment or multiple appointments to receive assessment and care. Some offices do not complete Workers' Compensation appointments but refer them to Occupational Medicine Clinics. Depending on the incident testing may be required such as the case with exposure to blood or bodily fluid from another. Some tests that may be ordered are Hepatitis B virus antibody screen or HBV IGG/IGM screen collected in a red topped tube and the Human Immunodeficiency Virus or HIV RNA types 1 & 2, drawn in a Serum separator tube or SST tube. There is also exists a Bloodborne Pathogen Exposure Profile with many labs that covers HBV, HCV and HIV, which is collected in either a gold-topped tube or a red-topped tube.1
Department of Transportation (DOT) Physical Visits
Department of Transportation (DOT) Physical exams care for patients trying to acquire a Commercial Driver’s license. The provider will assess the patient's overall health and fitness for DOT.2 The patient leaves a urine sample for urinalysis, and the phlebotomist will take blood for a drug and alcohol test, which is commonly drawn in a Red topped tube.1
Blood Draw
Blood Draw appointments are typically scheduled with a Phlebotomist. During this appointment, the Phlebotomist will complete the blood draw for the patient based on orders previously placed for the patient by the clinician at a prior date or time. This appointment should only take 15 minutes at most.
The different types of visits depend on each office. Every office is unique, and some providers will request greater or fewer tests for each specific patient. Knowing how a medical office works and it’s protocols aids a Phlebotomist with their essential job duties. Interested in learning more? PhlebCE.com covers this and other topics that are both engaging and medically relevant topics for practicing Phlebotomists needing to expand their knowledge for continued education certification renewal.
References
- Lapcorp (2025, March 8). Lab test Directory. Labcorp. https://www.labcorp.com/test-menu/search
- Concentra (2019, September 30). What Does a DOT Physical Consist Of? Retrieved January 25, 2024, from https://www.concentra.com/resource-center/articles/what-does-a-dot-physical-consist-of/