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PHN

__________________________

STANDARD ELEMENTS

IMPLEMENTATION

  • 1.

    Completes and documents disease and health event investigation per PHN Practice Manual (p. C25).

  • 2.

    Refers client/household as needed

    • (p.

      C25).

  • 3.

    Documents health teaching/counseling regarding lead and nutrition were given to client and household members (p. C25).

  • 4.

    Monitors client’s adherence to CLPPP recommended frequency for blood lead level (p. C25).

  • 5.

    Ensures that all at-risk household members receive a blood lead level

    • (p.

      C25).

COMMENTS:

© 2007 LAC DPH-Public Health Nursing

RECORD #

RECORD #

RECORD #

(1)

(2)

(3)

Year

COMMENTS

April- Sept

Lead Standard of Practice Evaluation Form

Circle appropriate period

Oct-March

N/A

MET

NOT MET

MET

MET

NOT MET

N/A

NOT MET

N/A

F 29

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