Table 1.

A Basic Personal-Risk Questionnaire*

__Yes__No1.  Does your child live in or regularly visit a house or child care facility built before 1950?
__Yes__No2.  Does your child live in or regularly visit a house or child care facility built before 1978 that is being or has recently been renovated or remodeled (within the last 6 months)?
__Yes__No3.  Does your child have a sibling or playmate who has or did have lead poisoning?
  • * Adapted from the Centers for Disease Control and Prevention.13 The state or local health department may recommend alternative or additional questions based on local conditions. If the answers to the questions are “no,” a screening test is not required, although the provider should explain why the questions were asked to reinforce anticipatory guidance. If the answer to either question is “yes” or “not sure,” a screening test should be considered.