For Providers

Reporting Forms

• F09-11709: Child Blood Lead Reporting Form  - Revised August 2018
  Used by healthcare providers to report blood lead level(s) for children under 15 years of age.
  
  
• F09-11624: Adult Blood Lead Reporting Form
  Used by healthcare providers to report blood lead level(s) for children/adults 15 years of age and older.
  
  
• Pb-111: Point-Of-Care Blood Lead Testing Report- Created 04/26/12
  Used by healthcare providers to report blood lead levels when using an point-of-care blood lead analyzer.
  
  

Risk Questionnaire links

• Pb-110: Lead Risk Questionnaire (English Version) - Revised August 2018
  
• Pb-110: Lead Risk Questionnaire (Spanish Version) - Revised August 2018
  The lead risk questionnaire is located on page 2 of the "Texas Childhood Blood Lead Screening Guidelines: Quick Reference Guide."
  
  

Screening & Testing links

 2018 Texas Childhood Blood Lead Screening Guidelines - Revised August 2018

Targeted zip codes have one or more associated census tract in which:
• The percentage of children age 1-2 years old with a blood lead level ≥ 5 mcg/dL is ≥ 3% among those tested in 2016 (Prevalence), or 
• The percentage of residential structures built before 1950 is ≥ 27% (Housing).

Follow up forms

• Pb-102: Follow-up of Initial Elevated Blood Lead Level - Revised August 2018
  Used by healthcare providers for follow-up of elevated blood lead levels of a child. 
  
  
• Pb-104: Physician Checklist for Parent Education Topics - Revised August 2018
  Used by healthcare providers to determine the appropriate lead educational material to provide parents for medical care, environmental intervention, and nutritional intervention. 
  
  
• Pb-109: Reference for Blood Lead Retesting and Medical Case Management - Revised August 2018
  Used by healthcare providers to determine when follow-up blood lead testing is necessary. Specifically: “Schedule for Obtaining a Diagnostic Venous sample”, “Schedule for Follow-up Venous Blood Lead Testing After Diagnostic Venous Sample”, and “Recommendations for Children with Diagnostic Elevated Blood Lead Levels”. 
  
  

 Environmental Lead Investigation forms

• Pb-101: Request for Environmental Investigation - Revised August 2018
  Used by healthcare providers to request and Environmental Lead Investigation for a child with a venous blood lead level test result of 20 µg/dL and higher, or two separate venous blood lead level tests collected at least 12 weeks apart in the 10-19 µg/dL range. 
  
  
• Pb-103: Elevated Blood Lead Level Investigation Questionnaire - Revised August 2018
  Used by Lead Risk Assessors to conduct Environmental Lead Investigations.
  
  

Literature & Publications

• 1-312: Educator's Brochure: What all New Parents Need to Know…
  
  
• 1-313: Childhood Blood Lead Testing: Getting a Good Specimen (Poster)
  
  
• 1-314: Your Local Childhood Lead Poisoning Prevention Program (CLPPP) Is Here to Help You 
  
  
• Lead Information Sheets for Parents 
  
  
• Lead Poisoning Prevention Guidelines for Prenatal Care Providers in Texas