New Lead Poisoning Reporting Requirements

Office of Environmental Health

Why Did the Lead Poisoning Reporting Rule Change?

The Arizona Department of Health Services (ADHS) changed the reporting rule on December 12, 2000. The changes improve the ADHS’ ability to characterize disease patterns statewide, and to serve patients and reporting entities.

What Are the New Reporting Rule Requirements?

Clinical laboratory directors must report all blood lead test results to the ADHS.
Physicians must report all elevated blood lead levels of >10 micrograms per deciliter (µg/dL) for children and >25 µg/dL for adults.
All reports must include specific information on patient demographics, the laboratory that ran the test, and the ordering physicians.
Reports of severe blood lead levels, specifically >45 µg/dL in children and >60 µg/dL in adults, must be reported by physicians and laboratories within 1 working day. All other elevated blood lead levels must be reported within 5 working days. Laboratories must report all non-elevated results <10 µg/dL in children and <25 µg/dL in adults at least once every month.

What Changes Were Made to the Lead Poisoning Reporting Rule?

Clinical laboratory directors are now required to report all blood lead tests results. The previous rule required the reporting of only elevated blood lead levels, which were >10 micrograms per deciliter of blood or greater (µg/dL). Requiring laboratory directors to report all blood lead results to the ADHS enables the ADHS to assess disease prevalence rates and screening rates to characterize the scope of the lead poisoning problem in Arizona and thus to identify risk areas and design effective prevention programs. Physicians still report only elevated blood lead levels, as in the previous rule.

The adult blood lead level that is reportable by physicians is now 25 µg/dL. The previous rule required the reporting of all elevated blood lead levels of >10 µg/dL. The ADHS made this change in response to the National Institute for Occupational Safety and Health's identification of 25 micrograms per deciliter of blood as the level of concern for adults. Although physicians are no longer required to report adult lead level results of less than 25 micrograms per deciliter of blood, the ADHS still receives this information from clinical laboratory directors for tracking purposes.

More timely reporting of elevated blood lead levels. The previous rule required reporting the elevated blood lead level within 5 days of detection. Now the rule requires both physicians and laboratory directors to report blood lead levels at or above 45 micrograms per deciliter in children and at or above 60 micrograms per deciliter in adults within 1 working day of detection. All other elevated blood lead levels must be reported within 5 working days. Laboratories must report all non-elevated results <10 µg/dL in children and <25 µg/dL in adults at least once every month. The ADHS made these changes to ensure timely medical and environmental case follow-up in accordance with U.S. Centers for Disease Control and Prevention guidelines. The rule also provides that a physician or laboratory director may designate a representative to make the reports to the ADHS on behalf of the physician or laboratory director.

Additional demographic and contact information. The current rule requires both physicians and laboratory directors to report additional fields of information regarding the individuals tested for blood lead, the physicians ordering the tests, the laboratories performing the tests, and the blood draws. Many physicians and laboratory directors are currently providing much of this additional information to the ADHS as a courtesy. The ADHS needs this additional information in order to provide more effective case management and follow-up services. The ADHS has also eliminated the reporting requirement for race or ethnicity.

How Do I Report Blood Lead Test Results?

Reports may be phoned, mailed or faxed to the ADHS. If faxing, please call ahead to ensure confidentiality. Optional report forms are available from this office. Laboratories may report electronically, using specifications designed by the ADHS. The reporting rules are published in the Arizona Administrative Code. Copies of the rules are available from this office. The ADHS website for lead poisoning prevention also provides report forms and copies of the rules.

What Happens Once a Blood Lead Test Is Reported?

The ADHS conducts case follow-up for elevated venous or confirmed capillary results. Non-elevated results are used to characterize screening and disease prevalence statewide.

Children

10 µg/dL - 19 µg/dL: Prevention counseling by phone and educational materials and reminders for follow-up testing;
>20 µg/dL: Environmental investigations, which include in-home interview and environmental sampling to identify sources, specific intervention advice and prevention counseling, resource referrals, reminders for follow-up testing and summaries to the physician.

Adults

>25 µg/dL: Prevention counseling and referral to state OSHA, if applicable.

A downloadable version of New Lead Poisoning Reporting Requirements [PDF 45K] is available. The download is in PDF format. It is necessary to have Acrobat Reader^™ on your machine to view the download.