Lead QI Wave 1: Data Collection Tool

Lead Prevention - Data Collection
Does this child live in a high risk zip code? *
Is this child insured by Medicaid? *
Well child visit: *
Caregiver at visit: *
Select which of the following items were documented as anticipatory guidance to reduce exposure to lead:
Was there documentation ordering a lead test for this child?
Select test type ordered

FOLLOW UP SECTION- WAIT ONE MONTH TO REVIEW THE FOLLOWING ITEMS FOR CHILDREN ATTENDING 12- or 24-MONTH WELL VISITS

Was there documentation of a lead test being completed (either a note in the chart of results obtained or billing code from the lab) for this child?
Select the initial test type completed:
The test results were:
If positive for lead, the following items were documented for patient follow-up: