Beginning with the 2003-2004 school year, all students in Pre-Kindergarten, Kindergarten and First Grade must have a completed DHMH 4620 Form on file at the school. If the student lives or has ever lived in one of the Zip Codes listed on the back of the form they must have had Blood Lead Testing. The Health Care Provider must complete the DHMH 4620 form and sign it. Blood lead testing should be routinely done at 12 and 24 months. If the first test was done prior to 24 months, two lead tests must be performed. If the first test was done after 24 months, only one proof of testing is required. If the student has never lived in an at risk zip code, the parents may attest to that on the certificate. Parent signature in that area is sufficient to meet state requirements.
If there is a religious objection to the testing, and the student lives or has ever lived in an at risk Zip Code, a Health Care Provider must administer a Lead Risk Assessment Questionnaire and sign the DHMH 4620. You may obtain a copy of the DHMH 4620 form at your Elementary School, or by clicking on the link below:
Maryland Blood Lead Testing Certificate