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Task Number Task/ Activity/Description d) Interview the caregivers using the Child Blood Lead Investigation Form and conduct an environmental assessment to identify factors that may impact the child's blood lead level. If laboratory services are needed, contact DOH at lead@doh . wa . gov. Note: Laboratory services will not be reimbursed through the ConCon process. e) Determine if the family lives in Section 8 or HUD Housing. If the child is Medicaid enrolled collect the Provider One number f) Provide educational material to the child 's caregivers in the family 's primary language g) (Optional) If warranted, contact DOH to request technical or environmental investigation assistance with an X-ray fluorescent (XRF) analyzer Have the child retested following the Pediatric Environmental Health Specialty Units (PEHSU) medical management guidelines. If the lead level remains 2:5 µg /dL the LHJ will conduct a second home visit to connect the family to other service providers as needed. PEHSU medical management guidelines: htms://Y!_ww.11ehsu.ne t/ Llbrarv/fa c ts/medical -m~mnl- childhood-lead-exposure-June-?O 13.pdf If the second lead level drops to <5 µg/dL, the LHJ has the option to: 1) Mail the child's caregivers a letter recommending a developmental and nutritional screening, the letter will include providers in the child's residential area . The LHJ may then close the case. (DOH will provide a template letter.); or 2) proceed to Task 2 and conduct a second home visit. 2 The purpose of the second home visit is to connect the family to other service providers as needed: a) LHJ staff will facilitate and guide the child's caregiver in completing the WithinReach Exhibit A, Statements of Work Revised as of July 16, 2018 AMENDMENT #4 *May Support PHAB Due Date/Time Payment Standards/Measures Deliverables/Outcomes Frame Information and/or Amount f) (If applicable) IfDOH assistance is requested , list the DOH contact and date contacted g) (If applicable) If the LHJ opts to close the case after verifying that the second lead level has dropped to <5 µg/dL , it must submit a copy of the letter mailed to the family Submit a written report summarizing the environmental assessment lab test results and a Plan of Care that lists recommendations on how to remove and remediate lead exposure via WDRS . Include the educational material provided to the family that addresses the child's needs. (DOH will provide a generic template.) The LHJ will fH'0+'ide upload a copy of the report to DOH via WDRS , and provide a copy to the child's caregivers and provider. Submit an updated Plan of Care to Memh!;,·. e_;• .the Reimbursement of up DOH via WDRS and provide a copy .J.if'-efake to $500 maximum per to the child's caregivers and provider ~,;g-mem-ltc-home visit, per child. that includes: Submit as needed Up to two (2) home Page 4 of32 Contract Number CLH18249-4