N.H. Admin. Code § He-P 1603.04
"I understand that by not testing my child's blood, neither I, nor my physician, will know if my child has an elevated blood lead level. I understand that young children exposed to lead often look and act healthy, demonstrating no outward signs or symptoms to illness. I understand that young children are especially vulnerable to lead exposure due to their normal developmental behaviors (for example, orally ingesting lead paint and dust) and lead can accumulate in their bodies over time. I understand that an elevated blood lead level can negatively affect my child's neurological and behavioral development, including speech and language development, memory and learning, hearing, self-regulation and control, muscle motor skills, and coordination, and can result in increased impulsivity and aggressions. If high enough, lead exposure could lead to convulsions, coma, and even death";
"My physician has reviewed the risks associated with my child having an elevated blood lead level with me"; and
"I understand that I may reverse my decision at any time and have my child tested for elevated blood lead levels through a simple test."; or
"As the attending physician, I hereby certify that blood lead level testing may be detrimental to this patient's health. I acknowledge that this exemption shall only exist for the length of time that I believe testing would be detrimental to the child."
N.H. Admin. Code § He-P 1603.04