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Blood cholesterol screening programs offer an important venue for nutrition counseling aimed at lowering blood cholesterol levels. This paper presents a screening, counseling and referral protocol that has been developed by the Pawtucket Heart Health Program (PHHP). A review of general considerations for counseling strategies in the screening context highlights the necessity for brief, focused, behaviorially oriented tactics. The PHHP Summary and Referral protocol includes a review of multiple risk factors for heart disease, a discussion of blood cholesterol levels, recommendations for eating pattern changes based on response to a food frequency questionnaire, and a final summary and referral as needed. The training of lay volunteers and health professionals in delivery of the program is also reviewed