Each health care provider or health care facility that has obtained parental consent shall, as part of a well-child care visit, perform a blood lead level (BLL) screening test on every child who resides in the District of Columbia and who is served by the provider or facility, unless an identical test was performed not more than twelve (12) months before the well-child visit. Blood lead level screening tests shall be performed according to the following schedule:

1. (a) Once between the ages of six (6) months and fourteen (14) months;
2. (b) Once between the ages of twenty-two (22) and twenty-six (26) months; and
3. (c) At least twice if a child over the age of twenty-six (26) months has not previously been tested for BLL. The tests for children over the age of twenty-six (26) months shall be conducted before the child attains the age of six (6) years and shall be conducted at least twelve (12) months apart, or according to a schedule determined appropriate by the health care provider or health care facility.

When a health care provider or health care facility required to provide testing pursuant to this chapter does not administer a BLL test during a well-child visit and according to the schedule provided in § 7301.1, the health care provider or health care facility shall document in the child's health record the reason for not performing the BLL test.

Each health care provider and health care facility shall conduct additional BLL screening when any of the following circumstances are present:

1. (a) When a child is at risk for high-dose lead exposure based on the child's living conditions, a parent's occupational exposure to lead, a history of lead poisoning in siblings or playmates, or as indicated because of the child's behavior or development. In determining whether a child is at risk for high-dose lead exposure, each health care provider and health care facility shall determine, through the use of a personal-risk questionnaire or by other appropriate means, whether any of the following risk indicators are present:

2. (1) The child lives in, or frequently visits, deteriorated housing built before 1978;

3. (2) The child lives in, or frequently visits, housing built before 1978, with recent, ongoing, or planned renovation or remodeling;
4. (3) The child's siblings, housemates, or playmates have confirmed lead poisoning;

(4) The child's parent, guardian, or other household members participate in occupations or hobbies that may result in exposure to lead; or

(5) The child lives, or has lived, near industrial facilities or operations that may release atmospheric lead;

(b) The child exhibits pica, which consists of repeated ingestion of nonfood substances, or has frequent hand-to-mouth activity; or

(c) The child has unexplained seizures, neurological symptoms, abdominal pain, or other symptoms consistent with lead poisoning, including growth failure, developmental delay, attention deficit, hyperactivity, behavioral disorders, school problems, hearing loss, or anemia.

7301.4 Each health care provider or health care facility shall provide family lead education and appropriate referrals for social and environmental services to the family of a child with an elevated blood lead level.

SOURCE: Final Rulemaking published at 52 DCR 9852 (November 4, 2005); as amended by Final Rulemaking published at 60 DCR 10909 (July 26, 2013).