- Medical Management Guidelines for Providers
- Childhood Blood Lead Medical Management Guidelines for Providers in Indiana UPDATED: October 1, 2022
The Childhood Blood Lead Medical Management Guidelines for Providers in Indiana provide guidance for the treatment, medical management and follow-up of children with elevated blood lead levels. These guidelines represent a set of best practices and recommendations for health care providers working with children exposed to lead. Health care providers may include physicians, physician assistants, nurse practitioners and other health professionals in a medical setting who serve and treat individuals who have received a blood lead test.
- Reporting Requirements
- Indiana statute (410 IAC 29-3-1) requires that ALL blood lead tests, REGARDLESS OF RESULTS are required to be reported to IDOH by the entity examining the specimen (i.e. Laboratory, Clinic, Physician, etc.) not later than one (1) week after completing the test.
- The IDOH Lead and Healthy Homes Division can accept blood lead level testing results through HL7 messaging OR direct entry into the Lead Data Flow (LDF) database and beginning January 1, 2023, through the Children and Hoosier Immunization Registry Program (CHIRP)
- Direct Entry:
- Lead Data Flow (LDF): Blood lead level test results can be entered directly into LDF electronic gateway portal. An account will be created for each person that reports test results. Instructions for signing up to obtain an account for reporting blood lead test results into LDF are found here.
- Children and Hoosier Immunization Registry Program (CHIRP): EFFECTIVE 1/1/2023 Providers can enter blood lead test results directly into CHIRP as a means for submitting results to IDOH. Entered test results remain editable after submission. Contact the CHIRP Help Desk at 1-888-227-4439 for problems accessing CHIRP. Contact Scile Wilz at firstname.lastname@example.org with other questions.
- HL7 messaging:
- Direct Entry:
- IDOH can also accept test results through secure fax or secure email, but this method is not recommended as the best option for submitting blood lead level testing results and should be considered a temporary or short-term option for submitting results. Per 410 IAC 29-3-1(b) any provider or lab submitting more than 50 results per year will be required to report electronically.
- Laboratory Reporting Form - This form is only used for individual, single use reporting of blood lead test results sent via fax to IDOH.
- Questions about blood lead level reporting or signing up for electronic reporting, please contact Hazarath Thanneeru: email@example.com.
- Testing Requirements
Universal Screening (Testing)
On March 10, 2022, Governor Holcomb signed House Enrolled Act (HEA) 1313 into law requiring healthcare providers to confirm that children under 7 have been tested for lead, and if not, to offer this testing to the parent or guardian of that child. The bill is slated to take effect January 1, 2023.
Guidance and Standards for Health Care Providers
- To ensure uniformity between HEA 1313 and the Medicaid Early and Periodic, Screening, Diagnostics, and Treatment (EPDST) guidelines, IDOH is requiring all providers to follow the steps below:
- Children should receive a blood lead test between the ages of nine (9) and thirteen (13) months, or as close as reasonably possible to the patient’s appointment.
- Children should have another blood lead test between the ages of twenty-one (21) and twenty-seven (27) months, or as close as reasonable possible to the patient’s appointment.
- Any child between twenty-eight (28) and seventy-two (72) months that does not have a record of any prior blood lead test must have a blood lead test performed as soon as possible.
- If a provider can verify, via the Children’s Health and Immunization registry Program (CHIRP), or the records from another provider, that blood lead testing has occurred at the required interval(s), they are not obligated to repeat the procedure.
- If a parent or guardian refuses to allow their child to be tested, providers are encouraged to document the refusal in writing and have the parent or guardian sign an attestation of refusal.
- CDC Childhood Lead Poisoning Prevention: Healthcare Providers – Resources and information on lead screening, reporting, medical management, education and other lead health issues for health care providers.
- CDC Childhood Lead Poisoning Prevention Program – CDC’s web page is filled with lead-related resources and information for parents & caregivers, healthcare providers and public health professionals
- American Academy of Pediatrics (AAP) information on lead exposure – information and resources for physicians on prevention and medical management
- “Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention” – Report of the CDC’s Advisory Committee on Childhood Lead Poisoning Prevention.
- PEHSU Region 5 – Great Lakes Center for Children’s Environmental Health. Resource for information and physician consult.
- Guidelines For the Identification and Management of Lead Exposure in Pregnant and Lactating Women (2010) – These guidelines are based on scientific data and practical considerations regarding preventing lead exposure during pregnancy, assessment and blood lead testing during pregnancy, medical and environmental management to reduce fetal exposure, breastfeeding, and follow up of infants and children exposed to lead in utero. (CDC)
- Indiana Poison Control: 1-800-222-1222
- ATSDR Toxicological Profile for Lead – information on the toxicology and adverse health effects of lead.