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Get the free Department of Health 's Blood Lead Test Report Form - doh wa

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Blood Lead Level Reporting OFFICE USE ONLY DOH ID Number Date ReceivedPATIENT INFORMATION Patients Name (Last, First, Middle Initial)TelephoneStreet Address CityStateZipCountyAgeDate of BirthSexMaleFemaleUnknown
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How to fill out Department of Health s Blood Lead Test

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How to fill out Department of Health s Blood Lead Test

01
Obtain the Department of Health's Blood Lead Test form from their official website or local health department office.
02
Fill in your personal information, including name, address, and date of birth.
03
Specify the reason for testing in the designated section of the form.
04
Check the box indicating whether you consent to the blood lead test for your child or yourself.
05
Provide information about any potential lead exposure sources, such as housing conditions or occupational hazards.
06
Sign and date the form to confirm the information is accurate.
07
Submit the completed form at your local health department or designated testing site as instructed.

Who needs Department of Health s Blood Lead Test?

01
Children under the age of six, especially those living in older homes with potential lead-based paint.
02
Pregnant women who may be at risk of lead exposure.
03
Individuals who work in industries that may expose them to lead.
04
Anyone who shows symptoms of lead poisoning or has been in contact with lead sources.
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The Department of Health's Blood Lead Test is a diagnostic procedure used to measure the level of lead in a person's blood to assess potential lead exposure and its health effects.
Individuals, especially children under the age of six, and pregnant women who may be at risk of lead exposure are typically required to undergo the Blood Lead Test. Healthcare providers may also be mandated to report elevated lead levels to the Department of Health.
To fill out the Department of Health's Blood Lead Test form, gather necessary patient information such as name, date of birth, address, and any relevant medical history. Complete all sections accurately, including the reason for the test, and submit it according to local health department guidelines.
The purpose of the Blood Lead Test is to screen for lead poisoning, identify individuals at risk, guide public health interventions, and monitor environmental lead exposure in the population.
The information that must be reported includes the patient's demographic details, the blood lead level result, date of the test, the provider's information, and any follow-up recommendations based on the results.
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