PDFWAC 246-491-029
Information collected on the confidential section of live birth and fetal death certificates; modifications to the United States standard certificates and report forms.
(1) Effective January 1, 2003, the department shall use the 2003 revisions of the United States standard forms of live birth and fetal death as the basis for the state certificates of live birth and fetal death. These forms are developed by the United States Department of Health and Human Services, National Center for Health Statistics.
(2) Copies of these forms may be obtained by contacting the department's center for vital statistics.
(3) Tables 1 and 2 list the statistical information contained in the confidential sections of the birth and fetal death certificates that the board requires the department to collect, and the differences between the state and U.S. standard.
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" |
[Statutory Authority: RCW 43.70.150, 70.58.055, and chapter 70.58 RCW. WSR 02-20-092, § 246-491-029, filed 10/1/02, effective 11/1/02. Statutory Authority: Chapter 70.58 RCW. WSR 91-20-073 (Order 196B), § 246-491-029, filed 9/26/91, effective 10/27/91. Statutory Authority: RCW 43.20.050. WSR 91-02-051 (Order 124B), recodified as § 246-491-029, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 70.58.200. WSR 88-19-092 (Order 310), § 248-124-010, filed 9/20/88. Statutory Authority: RCW 43.20.050 and 70.58.200. WSR 84-02-004 (Order 270), § 248-124-010, filed 12/23/83; Order, § 248-124-010, filed 9/1/67.]