Attachment 5b. Childhood Blood Lead Surveillance (CBLS) Aggregate Records Form |
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Number of Children Tested and Confirmed in [NAME OF JUSRISDICTION] by BLL Group, Children < 72 Months Old |
Year |
Number of Children Tested* |
Total Confirmed BLL ≥10 µg/dL |
Confirmed BLLs ≥10 µg/dL as % of Children Tested* |
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Number of Confirmed Children By Highest Blood Lead Level (µg/dL) at or Following Confirmation |
5-9 µg/dL^ |
10-14 µg/dL |
15-19 µg/dL |
20-24 µg/dL |
25-44 µg/dL |
45-69 µg/dL |
≥70 µg/dL |
≥5 µg/dL^ |
Quarter X (Month - Month) 202X |
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All data obtained from the [NAME OF AWARDEE] Program. |
* Unprocessed BLL records not included; all unprocessed records are <5 µg/dL. |
^ Blood lead levels 5-9 μg/dL are counted as a single capillary or venous sample. |