For Providers

Welcome to the Texas Blood Lead Surveillance Provider's Resources Page. Here you can find up-to-date paperwork for testing, reporting, and conducting follow-up visits for children who test for elevated blood lead levels. You can use the list below to find our resources by category.

• Texas Blood Lead Surveillance Reporting Videos
• Reporting Blood Lead Levels
• Screening & Testing for Lead in Children
• Follow-up Forms
• Environmental Lead Investigation Forms

Texas Blood Lead Surveillance Videos

The Texas Department of State Health Services has developed training videos on testing children for lead, reporting the results, and conducting follow-up.

• Importance of Childhood Lead Testing and Reporting
• Ways to Report Blood Lead Test Results
• Follow-up for Elevated Lead Levels

Reporting Blood Lead Levels

By Electronic Submission

• Electronic Reporting Form
• Texas Blood Lead Surveillance: Ways to Report Blood Lead Test Results
  Used by healthcare providers to submit blood lead test results by electronic submission or by fax.

By Fax

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

Screening & Testing for Lead in Children

• 2019 Texas Childhood Blood Lead Screening Guidelines -  Revised February 2019
  Unsure who to screen? Use our guideline to determine what child needs to be tested based on their health insurance and targeted zip code.
  
• Pb-110: Lead Risk Questionnaire (English Version) - Revised August 2018
  The lead risk questionnaire is also included in the "2019 Texas Childhood Blood Lead Screening Guidelines" document, on page 8.
  
  • Pb-110: Lead Risk Questionnaire (Spanish Version) - Revised August 2018
  • Pb-110: Lead Risk Questionnaire (French Version) - Created February 2020
  • Pb-110: Lead Risk Questionnaire (Arabic Version) - Created February 2020
  • Pb-110: Lead Risk Questionnaire (Burmese Version) - Created February 2020
    

Follow-up Forms

• Follow-up of Initial Elevated Blood Lead Level (Pb-102) - Revised August 2018
  Used by healthcare providers for follow-up of elevated blood lead levels of a child. 
  
• Physician Checklist for Parent Education Topics (Pb-104) - 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. 
  
• Reference for Blood Lead Retesting and Medical Case Management (Pb-109) - 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

• Request for Environmental Investigation (Pb-101) - 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. 
  
• Elevated Blood Lead Level Investigation Questionnaire (Pb-103) - Revised August 2018
  Used by Lead Risk Assessors to conduct Environmental Lead Investigations.