Form 0920-0931 Childhood Blood Lead Surveillance (CBLS) Aggregate Recor

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Overview

QX 202X
QX 202X Unprocessed BLLs

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Sheet 1: QX 202X

Attachment 5b. Childhood Blood Lead Surveillance (CBLS) Aggregate Records Form
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*		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
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.

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Sheet 2: QX 202X Unprocessed BLLs

Period	Number of Unprocessed BLLs
Quarter X (Month - Month) 202X
Unprocessed BLLs have not yet been matched to patient records. If processed, the number of children tested in the given period would be expected to increase. All unprocessed records are for BLLs <5 µg/dL.