County Health Departments

Lead Screening Protocols and Questionnaires

• Lead Screening Protocols for Children (pdf) - Fact sheet summarizing Oregon's Lead Screening Plan
• Questionnaires: 
• Clinic staff questionnaire (pdf) - Administered by clinic staff
• Parent questionnaire - Completed by parents/guardians
  English (pdf), Spanish (pdf), Russian (pdf), Vietnamese (pdf)

Case Management

The following are resources for county health department professionals working to provide lead poisoning case management. Some of the documents are in Word format so that they can be modified and used as templates.

• Childhood lead poisoning case management checklist (pdf)
• Sample letter for unconfirmed blood lead level - English (Word) and Spanish (Word)
• Sample letter for blood lead level of greater than or equal to 5 ug/dL (Word)
• Medical information form (pdf) - Completed by child's medical provider
• Lead poisoning case management best practices (pdf)
• Early Intervention/Early Childhood Special Education (EI/ECSE) Referral - Children diagnosed with lead poisoning may be eligible for EI/ECSE services.
• WIC rack card (pdf) - Eligibilty information for families with lead-exposed children
• Childhood Lead Poisoning Case Management & Investigation webinar (pptx) - From 1/4/2023 Orpheus webinar series
  

More case management resources...

Environmental Investigation

• Environmental investigation procedures (pdf)
• Investigation questionnaire (pdf)
• HUD Fillable Form 16.1 Resident Questionnaire for Investigation of Children with Elevated Blood Lead Levels (EBLLs) (Word)(PDF)
• HUD Fillable Form 16.1 in Spanish (Word)(PDF)
  
• Follow-up letter to parents/guardians - English (Word) and Spanish (Word)
• Spice and Home Remedy Survey (pdf)
  

Guidelines and Forms