IDPH's Illinois Lead Program uses this one-page form to receive blood lead test results. A clinician meets it when the practice or facility performs the blood lead test itself, for example with point-of-care testing. It records the patient, the test date, whether the sample was venous or capillary, the result in mcg/dL, and the provider and testing facility.
The health care provider or testing facility that performed the test completes the whole form, including the provider's credentials and the lab ID, and prints the name of the person completing it.
Download the current version from the source each time; forms change without notice.
Report of Blood Lead Test Result
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
The form sets three timeframes by result: 35.1 µg/dL or higher within 24 hours, 3.5 to 35 µg/dL within 48 hours, and 0 to 3.4 µg/dL within 30 days. Every result is reported to the Illinois Lead Program, not only elevated ones.
The Report of Blood Lead Test Result tells providers to use IDPH's prenatal form for pregnant patients. The general form is for everyone else, and it is a one-page fillable PDF printed under Illinois printing order IOCI 25-1279.