MARYLAND DEPARTMENT OF HEALTH BLOOD LEAD TESTING CERTIFICATE
For a copy of this form in another language, please contact the MDH Environmental Health Helpline at (866) 703-3266.
MDH 4620 Environmental Health Bureau
Revised 07/23 mdh.envhealth@maryland.gov
How To Use This Form
A health care provider may provide the parent/guardian with a copy of the child’s blood lead testing
results from ImmuNet as an alternative to completing this form (COMAR 10.11.04.05(B)).
Maryland
requires
all child
ren to be te
sted at
the 12 and 24 month well-child visits (at 12-14 and 24-26 months old respectively), and both test results should be included on this form (see COMAR 10.11.04). If the test at the 12-month
visit was missed, then the results of the test after 24 months of age is sufficient. A child who was not tested at 12 or 24
A parent/guardian and a child’s health care provider should complete this form when enrolling a child in child care, pre-
kindergarten, kindergarten, or first grade. Completed forms should be submitted by the parent/guardian to the
Administrator of a licensed child care, public pre-kindergarten, kindergarten, or first grade program prior to entry. The
child’s health care provider may record the test dates and results directly on this form and certify them by signing or
stamping the signature sections. A school health professional or designee may transcribe onto this form and certify test
dates from any other record that has the authentication of a medical provider, health department, or school. All forms are
kept on file with the child’s school health record.
Frequently Asked Questions
All children in Ma
ryland should be te
sted for lead pois
oning at 12 and 24 m
onths of age.
2. What is the blood lead reference value, and how is it interpreted?
Maryland follows the CDC blood lead reference value, which is 3.5 micrograms per deciliter (μg/dL). However,
there is no safe level of lead in children.
3. If a capillary test (finger prick or heel prick) shows elevated blood lead levels, is a confirmatory test required?
Yes, if a capillary test shows a blood lead level of ≥3.5 μg/dL, a confirmatory venous sample (blood from a vein) is
needed. The higher the blood lead level is on the initial capillary test, the more urgent it is to get a confirmatory
venous sample. See Table 1 (CDC) for the recommended schedule.
4. What kind of follow-up or case management is required if a child has a blood lead level above the CDC blood
lead reference value?
(https://www.cdc.gov/nceh/lead/advisory/acclpp/actions-blls.htm).
5. What programs or resources are available to families with a child with lead exposure?
• Maryland Home Visiting Services for Children with Lead Poisoning
For more information about these and other programs, call the Environmental Health Helpline at (866) 703-3266 or
visit: https://health.maryland.gov/phpa/OEHFP/EH/Pages/Lead.aspx.
Maryland Department of the Environment Center for Childhood Lead Poisoning Prevention:
https://mde.maryland.gov/programs/LAND/LeadPoisoningPrevention/Pages/index.aspx
Families can also contact the Mid-Atlantic Center for Children’s Health & the Environment Pediatric Environmental
Health Specialty Unit – Villanova University, Washington, DC.
Phone: (610) 519-3478 or Toll Free: (833) 362-2243
Website: https://www1.villanova.edu/university/nursing/macche.html