U.S. STANDARD CERTIFICATE OF LIVE BIRTH | ||
TABLE 1: Confidential Birth Certificate Items | ||
Item Number | Item Name | Difference from U.S. Standard, if any |
15 | Is mother married to the father? | |
If no, was mother married to anyone during the pregnancy? | Added | |
Has the paternity affidavit been signed? | ||
20 | Mother's education | Add "Specify": next to box for "8th Grade or less" |
21 | Mother of Hispanic origin? | |
22 | Mother's race | |
23 | Mother's occupation | Added |
24 | Mother's kind of business/industry | Added |
29 | Father's education | Add "Specify": next to box for "8th Grade or less" |
30 | Father of Hispanic origin? | |
31 | Father's race | |
32 | Father's occupation | Added |
33 | Father's kind of business/industry | Added |
34 | Mother's medical record number | |
35 | Mother's prepregnancy weight | |
36 | Mother's weight at delivery | |
37 | Mother's height | |
38 | Did mother get WIC food for herself during pregnancy? | |
39 | Cigarette smoking before and during pregnancy | |
40a | Number of previous live births | |
40b | Date of last live birth | |
41a | Number of other pregnancy outcomes | |
41b | Date of last other pregnancy outcome | |
42a | Date of first prenatal care visit | |
42b | Date of last prenatal care visit | |
43 | Total number of prenatal visits for this pregnancy | |
44 | Date last normal menses began | |
45 | Was mother transferred to higher-level care for maternal medical or fetal indications for delivery? | |
46 | Principal source of payment for this delivery | Add "Indian Health" and "CHAMPUS" |
47 | Newborn medical record number | |
48 | Birth weight | |
49 | Infant head circumference | Added |
50 | Obstetric estimate of gestation | |
51 | Apgar score at 5 min; if score is less than 6, score at 10 minutes | |
52 | Plurality | |
53 | If not single birth - born 1st, 2nd, 3rd etc. | |
54 | Was infant transferred within 24 hours of delivery? | |
55 | Is infant living at time of the report? | |
56 | Is infant being breastfed? | |
57 | Risk factors in this pregnancy | Add "Group B streptococcus culture positive" |
58 | Method of delivery | |
59 | Infections present and/or treated during this pregnancy | Add "HIV infection" and "Other: Specify" |
60 | Obstetric procedures | |
61 | Abnormal conditions of the newborn | |
62 | Characteristics of labor and delivery | |
63 | Congenital anomalies of the newborn | |
64 | Maternal morbidity | |
65 | Onset of labor |
U.S. STANDARD REPORT OF FETAL DEATH | ||
TABLE 2: Confidential Fetal Death Certificate Items | ||
Item Number | Item Name | Difference from U.S. Standard, if any |
38 | Weight of fetus | |
39 | Obstetric estimate of gestation | |
40 | Plurality | |
41 | If not single birth - Born 1st, 2nd, 3rd etc. | |
42 | Mother's education | Add "Specify": next to box for "8th Grade or less" |
43 | Mother of Hispanic origin? | |
44 | Mother's race | |
45 | Mother's occupation | Added |
46 | Mother's kind of business/industry | Added |
47 | Mother married? | |
48 | Mother's height | |
49 | Did mother get WIC food for herself during pregnancy? | |
50 | Mother's prepregnancy weight | |
51 | Mother's weight at delivery | |
52 | Date last normal menses began | |
53 | Date of first prenatal care visit | |
54 | Date of last prenatal care visit | |
55 | Total number of prenatal visits for this pregnancy | |
56a | Number of previous live births | |
56b | Date of last live birth | |
57a | Number of other pregnancy outcomes | |
57b | Date of last other pregnancy outcome | |
58 | Cigarette smoking before and during pregnancy | |
59 | Was mother transferred to higher-level care for maternal medical or fetal indications for delivery? | |
60 | Father's education | Added |
61 | Father of Hispanic origin? | Added |
62 | Father's race | Added |
63 | Father's occupation | Added |
64 | Father's kind of business/industry | Added |
65 | Risk factors in this pregnancy | |
66 | Method of delivery | |
67 | Congenital anomalies of the fetus | |
68 | Maternal morbidity | |
69 | Infections present and/or treated during this pregnancy | Add "HIV infection" and "Other: Specify" |
Wash. Admin. Code § 246-491-029
Statutory Authority: RCW 43.70.150, 70.58.055, and chapter 70.58 RCW. 02-20-092, § 246-491-029, filed 10/1/02, effective 11/1/02. Statutory Authority: Chapter 70.58 RCW. 91-20-073 (Order 196B), § 246-491-029, filed 9/26/91, effective 10/27/91. Statutory Authority: RCW 43.20.050. 91-02-051 (Order 124B), recodified as § 246-491-029, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 70.58.200. 88-19-092 (Order 310), § 248-124-010, filed 9/20/88. Statutory Authority: RCW 43.20.050 and 70.58.200. 84-02-004 (Order 270), § 248-124-010, filed 12/23/83; Order, § 248-124-010, filed 9/1/67.