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Lead Surveillance: MEDICAL QUESTIONNAIRE CONFIDENTIAL Washington Health System Occupational Medicine 95 Leonard Avenue, Bldg. 1, Suite 401, Washington, PA 15301 Phone: 7242233528 Fax: 7242292401 Name:
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How to fill out lead surveillance medical questionnaire
How to fill out a lead surveillance medical questionnaire:
01
Begin by carefully reading the instructions provided on the questionnaire. Make sure you understand the purpose of the questionnaire and the information it is asking for.
02
Clearly write your personal information, such as your full name, date of birth, and contact details, in the designated sections.
03
Provide accurate and detailed information regarding your occupational history. Include the dates, duration, and types of jobs or tasks that involved potential lead exposure.
04
Answer the questions about any previous lead exposure or previous medical testing for lead levels. Be honest and provide as much information as possible.
05
If you are currently employed in a lead-related industry or if you are being referred for lead surveillance, answer the questions related to your current job and potential exposure.
06
In cases where you have had medical testing for lead levels in the past, provide the dates, results, and any relevant medical documentation.
07
If you have been previously diagnosed with any lead-related health issues or symptoms, make sure to note them in the questionnaire.
08
If there is a section for additional comments or information, use it to explain any specific concerns or details that you believe are relevant for your lead surveillance.
09
Review your answers before submitting the completed questionnaire to ensure accuracy and completeness.
10
If you have any doubts or questions about filling out the questionnaire, it is advisable to seek clarification from a healthcare professional, your employer, or the relevant authority.
Who needs lead surveillance medical questionnaire?
01
Individuals working in lead-related industries such as construction, painting, battery manufacturing, and plumbing often require lead surveillance medical questionnaires.
02
Employees who have been exposed to lead as part of their work responsibilities or in their work environment may be required to complete this questionnaire.
03
Individuals who are being referred for lead surveillance due to potential lead exposure based on their occupation or medical conditions may also need to fill out a lead surveillance medical questionnaire.
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What is lead surveillance medical questionnaire?
Lead surveillance medical questionnaire is a form used to monitor the health of individuals who may have been exposed to lead in their workplace.
Who is required to file lead surveillance medical questionnaire?
Employers are required to file lead surveillance medical questionnaires for employees who may be at risk of lead exposure.
How to fill out lead surveillance medical questionnaire?
The lead surveillance medical questionnaire should be filled out by the employee with assistance from a healthcare provider if necessary.
What is the purpose of lead surveillance medical questionnaire?
The purpose of lead surveillance medical questionnaire is to monitor and assess the health of individuals exposed to lead, and to prevent adverse health effects.
What information must be reported on lead surveillance medical questionnaire?
The lead surveillance medical questionnaire must include personal information, medical history, and details of lead exposure.
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