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CHILDHOOD LEAD POISONING CONTROL PROGRAM ILLINOIS DEPARTMENT OF PUBLIC HEALTH CONSENT FORM Child to be Tested (Please Print): LastFirstDate of Birth / / Middleware (9 all that apply): Gender (circle)
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How to fill out childhood lead poisoning control

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How to fill out childhood lead poisoning control

01
Step 1: Gather all necessary information and documents related to the child's lead poisoning history.
02
Step 2: Start by filling out the child's personal information, including their name, date of birth, and contact information.
03
Step 3: Provide details of the child's previous lead poisoning tests and results.
04
Step 4: Specify any treatments or interventions that have been implemented to address the lead poisoning.
05
Step 5: Fill out the sections related to the child's living environment, including the presence of lead-based paint, water sources, and other potential lead hazards.
06
Step 6: Include information about any renovations or repairs done to the child's home or daycare facility that may have exposed them to lead.
07
Step 7: Provide information about any existing lead abatement programs or services utilized by the child or the child's family.
08
Step 8: Review the completed form for accuracy and make any necessary corrections or clarifications before submission.
09
Step 9: Submit the filled-out form to the relevant authority or organization responsible for childhood lead poisoning control in your area.
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Step 10: Follow up on the submission and ensure that all necessary actions are taken to address the child's lead poisoning.

Who needs childhood lead poisoning control?

01
Children who have been exposed to lead in their environment or have shown signs of lead poisoning.
02
Families or individuals living in areas with a high risk of lead contamination.
03
Healthcare providers and professionals working with pediatric patients who may be at risk of lead exposure.
04
Local authorities and organizations responsible for public health and safety.
05
Parents or guardians concerned about their child's lead exposure or potential lead poisoning.
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Childhood lead poisoning control is a program aimed at preventing and reducing lead exposure in children, which can have harmful effects on health.
Healthcare providers, landlords, and other individuals or entities responsible for the care and living conditions of children are required to file childhood lead poisoning control.
To fill out childhood lead poisoning control, individuals must provide information on the child's exposure to lead, any testing or treatment conducted, and follow-up measures taken to reduce exposure.
The purpose of childhood lead poisoning control is to track and monitor lead exposure in children, identify sources of exposure, and implement interventions to prevent and reduce lead poisoning.
Information reported on childhood lead poisoning control includes the child's demographics, lead exposure history, lead testing results, and any interventions or follow-up actions taken.
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