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Kentucky Childhood Lead Poisoning Prevention Program Case Manager Form (2020) Fax to (502)5645766 County:Date:Patient Name:Case Manager:DOB:Siblings under 6 years of age:Referred by PCP? Yes No Date:
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01
To fill out Kentucky Childhood Lead Poisoning Form, follow the steps below:
02
Obtain the form from the Kentucky Department for Public Health website or request a physical copy.
03
Provide your personal information such as name, address, and contact details in the designated fields.
04
Fill in your child's information including their name, date of birth, and any relevant medical history.
05
Answer the questions related to your child's exposure to lead, including any potential sources of lead contamination in your home or environment.
06
If applicable, provide information about any tests or medical treatments your child has undergone for lead poisoning.
07
Sign and date the form to certify the accuracy of the information provided.
08
Submit the completed form to the relevant authority or follow the instructions provided for submission.

Who needs kentucky childhood lead poisoning?

01
The Kentucky Childhood Lead Poisoning Form is needed by individuals who suspect that their child may have been exposed to lead or have been diagnosed with lead poisoning.
02
This form is typically required by the Kentucky Department for Public Health or other relevant health authorities to track and monitor cases of lead poisoning in children.
03
Parents, guardians, healthcare professionals, or anyone responsible for the care of a child who may have been exposed to lead should complete this form.
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Kentucky childhood lead poisoning refers to the elevated blood lead levels found in children due to exposure to lead. This condition can result from various sources such as lead-based paint, contaminated soil, and lead in plumbing and household items.
Health care providers and laboratories that conduct blood lead testing on children are required to report cases of childhood lead poisoning in Kentucky.
To fill out the Kentucky childhood lead poisoning report, healthcare providers should complete the standard reporting form by including patient identification details, blood lead test results, and relevant clinical information.
The purpose of monitoring Kentucky childhood lead poisoning is to identify and respond to cases of lead exposure in children, to ensure timely intervention, and to implement public health strategies to reduce lead exposure.
The information that must be reported includes the child's name, date of birth, address, test date, blood lead levels, medical history, and any known environmental exposures.
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