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  2. 2013
  3. January
  4. P
  5. Pediatric screener Jan 2013
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Please enter your contact information so that we can contact you if you are a good fit for our research.
First Name : 
Last Name : 
City : 
State : 
Zip : 
Email Address : 
 
 
Pediatric practice information
 
 
What type of practice do you belong to?
 
Private Pediatric Practice – Solo
 
Private Pediatric/Multispecialty Practice - Group
 
Free Standing/Urgent Care
 
Community Health Center
 
Hospital Based
 
 
How many patients to you see each week (on average)?
   
 
 
Questions about lead poisoning
 
 
During 12 and 24 month well child visits, what percent of the time do you assess risk for lead poisoning by:
Using only a screening questionnaire
%
Using only a blood lead test
%
Using a blood lead test only if screening questionnaire is positive
%
No lead risk assessment performed
%
0
 
 
 
On average, how many times do you test a patient for lead poisoning between the ages of 0 and 5?
 
0
 
1
 
2
 
3
 
4
 
Other
 
 
 
Please indicate yes or no for the following questions:
Yes No
Have you heard of the LeadCare II Blood Lead in-office testing system?
Have you considered purchasing a LeadCare II?
Does your office use a LeadCare II today?
 
 
 
When you do a blood lead test, what percentage of the time do you use the following methods?
In-office diagnostic test
%
Draw sample and send blood to an external lab
%
Refer patient to a lab for blood draw and testing
%
Collect filter paper sample and send to lab for analysis
%
0
 
 
Please rate the following potential challenges of blood lead testing, in terms of their significance in your practice:
Significant challenge Moderate challenge Minor challenge Not a challenge N/A
Parent objection to venous draw
Parent/patient does not comply with referral to lab for test
Inconclusive lab test requiring a redraw
Lack of immediate results
Staff time to follow up on a positive test result
Ability to get patient to return for positive test follow up
Staff time needed for in-office testing
State reporting requirements
Private payer reimbursement for the in-office test
Medicaid reimbursement for the in-office test
Capitation preventing payment for the in-office test
 
 
 
Other in-office testing
 
What other blood-based, tests do you perform, or would you like to perform, in your office?
Perform in office now Would like to perform in office
Hemoglobin
CBC
Cholesterol
Bilirubin
Electrolytes
 
 
Other test? (please specify):
   
 
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