4/2004; Updated 3/18/2005 

 Birth Edit Specifications For the 2003 Revision of the 

U.S. Standard Certificate of Birth 

Note: This document replaces Instruction Manual Part 3a, 

“Classification and Coding Instructions for Live Birth Records” 
4/2004; Updated 3/18/2005 

Table of Contents 

U.S. Standard Certificate of Live Birth 

 

 GENERAL GUIDELINES 

OVERVIEW

FINAL REVIEW SCREEN

SUMMARY LETTER ON GUIDELINES FOR ELECTRONIC SYSTEMS

Item 2 TIME OF BIRTH

Item 3 SEX

Item 4 DATE OF BIRTH (infant) 

Items 5-7, 17, 26 FACILITY NAME; CITY, TOWN OR LOCATION OF BIRTH; COUNTY OF BIRTH;

FACILITY ID; PLACE WHERE BIRTH OCCURRED

Item 8b DATE OF BIRTH (mother) 

Item 8d BIRTHPLACE (state, territory, or foreign country) 

Item 9a-g RESIDENCE OF MOTHER: STATE; COUNTY; CITY, TOWN OR LOCATION;

 STREET AND NUMBER; APT. NO.; ZIP CODE; INSIDE CITY LIMITS? 

Item 10b DATE OF BIRTH (father) 

Item 15 MOTHER MARRIED? 

Item 20 MOTHER=S EDUCATION

Item 21 MOTHER OF HISPANIC ORIGIN? 

Item 22 MOTHER=S RACE

Item 23 FATHER=S EDUCATION

Item 24 FATHER OF HISPANIC ORIGIN? 

Item 25 FATHER=S RACE

Item 27 ATTENDANT=S NAME, TITLE, AND NPI 

Item 28 MOTHER TRANSFERRED FOR MATERNAL MEDICAL OR FETAL INDICATIONS 

 FOR DELIVERY? 

Item 29a-b DATES OF FIRST AND LAST PRENATAL CARE VISIT

Item 30 TOTAL NUMBER OF PRENATAL CARE VISITS FOR THIS PREGNANCY

Item 31 MOTHER=S HEIGHT

Item 32 MOTHER=S PREPREGNANCY WEIGHT

Item 33 MOTHER=S WEIGHT AT DELIVERY

Item 34 DID MOTHER GET WIC FOOD FOR HERSELF DURING THIS PREGNANCY? 

Items 35a-c, 36a-b NUMBER OF PREVIOUS LIVE BIRTHS- NOW LIVING, NOW DEAD; DATE OF LAST 

LIVE BIRTH; NUMBER OF OTHER PREGNANCY OUTCOMES; DATE OF LAST 

OTHER PREGNANCY OUTCOME

Item 37 CIGARETTE SMOKING BEFORE AND DURING PREGNANCY

Item 38 PRINCIPAL SOURCE OF PAYMENT FOR THIS DELIVERY

Item 39 DATE LAST NORMAL MENSES BEGAN

Item 41 RISK FACTORS IN THIS PREGNANCY

Item 42 INFECTIONS PRESENT AND/OR TREATED DURING THIS PREGNANCY

Item 43 OBSTETRIC PROCEDURES

Item 44 ONSET OF LABOR

Item 45 CHARACTERISTICS OF LABOR AND DELIVERY

Item 46 METHOD OF DELIVERY
4/2004; Updated 3/18/2005 

Item 47 MATERNAL MORBIDITY

Item 49 BIRTHWEIGHT

Item 50 OBSTETRIC ESTIMATION OF GESTATION

Item 51 APGAR SCORE

Items 52, 53 PLURALITY; IF NOT SINGLE BIRTH- BORN FIRST, SECOND, THIRD, ETC. 

 (specify) 

Item 54 ABNORMAL CONDITIONS OF THE NEWBORN

Item 55 CONGENITAL ANOMALIES OF THE NEWBORN

Item 56 WAS INFANT TRANSFERRED WITHIN 24 HOURS OF DELIVERY? IF YES, 

 NAME OF FACILITY INFANT TRANSFERRED TO

Item 57 IS INFANT LIVING AT THE TIME OF REPORT? 

Item 58 IS INFANT BEING BREASTFED? 

File Processing Items State of Birth 

 Certificate Number 

 Void Flag 

 Auxiliary State File number 

 

Appendix A Country Codes 

Appendix B State, Territory, and Canadian Province Codes 

Appendix C City and County Codes 

Appendix D Hispanic Origin Look-up Table 

Appendix E Race Codes 
 4/2004; Updated 3/18/2005 

SPECIFICATIONS FOR COLLECTING AND EDITING 

THE UNITED STATES STANDARD CERTIFICATES OF BIRTH AND DEATH 

AND THE REPORT OF FETAL DEATH -- 2003 REVISION 

INTRODUCTION 

 

Since the inception of a national vital statistics system, the states and the federal government have worked together 

cooperatively to promote standards and consistency among state vital statistics systems. The U. S. Standard 

Certificates of Birth and Death, and Report of Fetal Death are the principal means of promoting uniformity in the data 

collected by the states. These documents are reviewed and revised approximately every 10 years through a process 

that includes broad input from data providers and users. In 1997, the National Center for Health Statistics (NCHS) 

appointed a panel of vital statistics data providers and users to evaluate the (1989) certificates. That panel completed 

its work in April 1999, and submitted recommended revisions to NCHS. 

NEED FOR SPECIFICATIONS 

As one of its findings, the panel recommended that NCHS develop and promulgate standards for vital statistics data 

collection and processing. One of the reasons for this was that the Working Group to Improve Data Quality found a 

decline in vital statistics birth data quality associated in part with electronic registration of vital events (1). 

Over the past 15 years, automation has had a significant effect on the nations’ vital statistics system. Currently, over 

95 percent of births are registered electronically and the move toward electronic death registration is accelerating. 

Unfortunately, these electronic systems were developed in a piecemeal fashion in an environment of constantly 

changing technology options. As a result, data quality issues not seen prior to the Electronic Birth Registration (EBR) 

systems began to surface. Many of these quality issues along with issues that appeared to be a problem for both paper 

and electronic systems are documented in the “Report of the Working Group to Improve the Quality of Birth 

Data.”(1) 

With the development of electronic systems for new standard certificates there is an opportunity to prevent some of 

the problems identified by the “Working Group” and improve data quality. One way to improve data quality as well 

as to ensure uniformity in the national databases is to include, as part of the implementation package, detailed 

specifications for electronic as well as paper systems. All vital statistics registration areas as well as software vendors 

will have the same set of specifications for data submission to NCHS. As a result, differences in data due to software 

created by different vendors should be minimized. 

Our goal is to offer comprehensive instructions/recommendations covering all aspects of the electronic system. The 

data specifications for electronic birth, death, and fetal death registration systems include: 

• Mechanisms for incorporating recommended worksheets into the system 

• Item specific edit criteria 
 4/2004; Updated 3/18/2005 

• Computational algorithms 

• Item code specifications 

• Response categories, including drop down menus and “pick lists” (excluding cause of death) 

• Requirements for context specific help 

• Electronic transmission standards 

The overall goal of these specifications is to have the electronic systems identify, and wherever possible, rectify data 

problems as close to data entry as possible. To that end, we recommend that the systems edit and query at the time 

the data is entered and that a second level of editing be performed for some items, once the record is filed with the 

state office. Editing performed close to the time that data are collected should greatly minimize queries from state 

offices to data providers. In addition, the editing and resolving of problems before data are transmitted to NCHS 

should reduce queries from NCHS to the states and maximize resolution of data problems before data are transmitted 

to NCHS when it is often too late for them to be fixed. 

At present, most Electronic Birth Registration (EBR) systems are designed for freestanding software in birthing 

facilities. The software captures the data, carries out limited editing, and transmits data to the state for further 

processing. State processing is then done either with software developed by the same vendor who developed the 

facility software, or by software developed by state staff. Although the current specifications are designed to be used 

with the different types of electronic systems (stand alone facility/provider software, state central processor, or 

central/ “web based,” systems) a system housed and operated centrally at the state office may facilitate system 

maintenance, version control, security, and uniform processing of data. 

We also strongly recommend that each state operated EBR/EDR input system replicate the data input system used by 

facilities/providers in the field. This helps to ensure that records not filed electronically will be keyed, edited, and 

processed as similarly as possible to electronically filed records. 

States may also wish to integrate the EBR and the Fetal Death Reporting system to minimize facility workload and 

promote more complete reporting. The new electronic systems may also be integrated with other public health data 

systems, such as newborn screening, immunization registries, medical examiner reporting systems, or other 

appropriate disease-specific reporting systems. However, the states should review how data are collected in these 

systems and the potential impact of this data on vital statistics information before allowing integration of systems. 

These specifications follow as closely as possible the data standards (HISSB standards) promulgated by the Centers 

for Disease Control and Prevention (CDC). 

The specifications include recommendations on the steps that should occur during data collection and processing, but 

do not specifically (with a few exceptions) mandate how the steps are to be operationalized. 

The specifications are meant to be software neutral. Any language that might be construed as mandating a particular 

software approach is not intentional. 

NCHS will review state software for the handling of data elements to ensure that data are collected and recorded as 

intended. The software will also be tested to ensure that the edits and computational algorithms work as intended, and 

that instructions and help menus, pick lists, and drop down menus are uniform. 

The EBR/EFDR specifications were developed assuming the NCHS Standard Worksheets (see attachments) as the 

source documents used to populate the EBR/EFDR. The standard worksheets are developed in a format that is the 

most efficient for hospital staff to complete. To further encourage the use of the worksheets the electronic systems 
 4/2004; Updated 3/18/2005 

must be designed to follow the flow of these worksheets. The paper worksheets are also readily adaptable to 

electronic formats (i.e., electronic worksheets). 

Most items on the Report of Fetal Death are similar or identical to those on the Birth Certificate. It is important that 

the EFDR also closely resemble the EBR so that comparable data may be collected from the two systems. 

GENERAL PRINCIPLES 

1. Electronic birth data are to be collected in a manner and format as similar to the recommended worksheets as 

possible. Death data should closely follow the death certificate.

2. The specifications for electronic systems include instructions that are to appear on the screen to complete each 

item and instructions to be included for help menus. 

3. The specifications for electronic systems include, in many cases, the specific edit screens to be followed at 

data input and at later stages in the processing. 

4. Once a record has been saved once and then reopened, the EDR/EBR/EFDR should include a window for the 

record that lists items still pending (incomplete). The keyer should be able to go to any item in the pending 

list and enter data when information becomes available. 

5. Default values are not permissible except for those clearly identified in the specifications. 

6. Individual check boxes or item responses may not be dropped, but State laws and regulations and individual 

State needs may dictate that additional categories be included. Any additions should be added to the end of the 

standard list. For exceptions to this recommendation please contact the Director of the Division of Vital 

Statistics, NCHS. 

7. State laws and regulations and individual State needs may also dictate that additional items be added to the 

certificate. Because additions may affect responses to the standard items, please contact the Director of DVS, 

NCHS before finalizing additional items. 

8. The certificates/worksheets generally do not include the response option “unknown.” Electronic systems, 

however, allow a final response of “unknown” for a number of items. 

9. Electronic non-check box numeric items such as dates, and “unknown” will require the entry of a character or 

series of characters as shown in the specifications. The use of “hot keys” for unknown values is 

recommended. 

10. The software must be able to integrate with several external pieces of software, e.g., the state GIS system, 

occupation and industry coding software, and Supermicar. 

11. Although quality control tabulations are not included in the specifications (e.g., the percent of unknown 

responses by provider), we strongly recommend that these types of tabulations be included as an essential 

component of the new EBR/EDR/EFDR systems. 

12. Software and table updates should be implemented uniformly across the state. 

FEATURES INTEGRAL TO THE ELECTRONIC SYSTEMS: 

• Automatic edits at time of data entry - automatic messages which appear immediately 

after data is entered for a given item. The message alerts the user of data problems (i.e., 

data out of range or inconsistent with other information) and allows the user to 

immediately modify the data. Cross-item edits, for example, maternal age by maternal 

education, should fire immediately after data for both items are entered. The user should 

not have discretion as to whether the edits are run. There are two types of edits - soft 

edits which identify and query entries but accept the entry upon the users approval, and 
 4/2004; Updated 3/18/2005 

hard edits which identify and query entries which must be corrected before the record can 

be filed. 

• Ability to edit related items together - the user should be able to readily modify data entered for 

all related items when an edit has identified a problem. For example, if birthweight is found to be 

within the allowable range, but is inconsistent with the (derived) length of gestation, the user 

should be able to readily correct both items since either could be inaccurate. 

 

• Capture of soft-edit query - the system should track when a soft edit has been performed. This 

will allow States to tract frequent edit failures and take corrective action. For selected variables, 

when a soft edit fails a second time, a by-pass variable will be set to alert States and NCHS that the 

out of range value has been verified as correct. 

• On screen messages - the individual item specifications include a number of 

reminders/instructions. A well-designed system should be able to incorporate these messages 

without unduly burdening the user. Not all messages should require action on the part of the user. 

For example, some messages can just be flashed on the screen quickly enough to read. 

• On-line help - definitions and more detailed instructions included in the specifications for both the 

EBR/EDR/EFDR and “The Guide to Completing the Facility Worksheet” for the EBR should be 

available on-line to the user. 

• Item order or flow - systems must flow in the same order as the worksheets which were designed 

to encourage information to be gathered from the best sources. (Not applicable to death.) 

• Final review/query screen - systems should be designed to allow the user to temporarily skip 

certain items to allow the user additional time to gather information, especially from the medical 

records. The final query screen reminds the user to complete all missing information and gives them 

the opportunity to do so before the record can be filed or released to the State data file. It also 

queries rare responses, such as a response of “no prenatal care.” Once a record is released to the 

State data file and is accepted by the State, providers should no longer have the ability to modify the 

record. 

• List of pending items - systems should allow the user to easily access a list of incomplete items 

and go to the incomplete items once a record has been worked on and saved once. Prior to sending 

or finalizing a record, it should be mandatory that the user be presented with a list of all incomplete 

items. 
GENERAL GUIDELINES, page 1 

4/2004; Updated 3/18/2005 

• For items where it is only correct to choose one response (e.g. Prepregnancy or 

Gestational Diabetes, or The Principal Source of Payment for Delivery) systems 

should be designed so as to accept only one response. Two possible ways to 

accomplish this are via edit messages or blocking out other response categories 

after one has been selected. 

 

• Version control - systems should include methods to track changes in software 

versions and notify NCHS of version change. Version changes considered 

necessary to track are ones which include changes to items, edits or more 

substantive changes to tables and format. Each record transmitted to NCHS 

should have a version number. This notice should greatly improve our ability to 

identify and fix data problems. 

• Cause of death 

- Consistent look for cause of death- On medical examiner, coroner, and 

physician entry screens, it is imperative that the physician viewing the 

screen be able to see, at minimum, the same prompts and formatting as 

those physicians using the paper version of the death certificate. (Not 

applicable to birth). 

- Additional lines for cause- Additional lines may be added as needed in 

the cause-of-death statement. (Not applicable to birth). 

- Prohibition of pick lists- Physicians completing cause of death MUST 

enter medical conditions using their own terminology (e.g., pick lists or 

other mechanisms limiting the choice for cause are not allowed). 

• Electronic death registration system guidelines- The National Association for 

Public Health Statistics and Information Systems' (NAPHSIS) Electronic Death 

Registration project has created guidelines and associated standards (see 

guidelines and standards at http://www.naphsis.org) for use in developing and 

implementing an electronic death registration system. The NAPHSIS document 

deals with broad issues while the NCHS specifications document deals with 

individual fields. 

 

TRANSMISSION FILE PRINCIPLES 

1. State file numbers should be sequential starting with the number one each year. 

2. Each shipment of data shall be accompanied by a transmittal that includes the file 

name, state name, date of shipment, certificate number range, and number of 

records in the shipment (new, updated and total). Each record shall include a 

variable which indicates that it is a valid record or a void. 

3. Data will be sent to NCHS as soon as possible after receipt and initial processing 
GENERAL GUIDELINES, page 2 

4/2004; Updated 3/18/2005 

by the state. The state shall not wait for the results of queries before transmitting a 

record. 

4. All record updates and changes to variables in the NCHS data set due to query, 

registrar initiation or interested party initiation should be forwarded to NCHS as 

soon as the updated record is accepted by the state. 

 

(1) Report of the Working Group to Improve the Quality of Birth Data. U.S. Department 

of Health and Human Services, PHS, CDC, NCHS. 1998. 

TERMS AND DEFINITIONS 

Soft Edit: An edit that identifies and queries entries which are outside of the 

expected range, but which accepts out of range entries. 

Hard Edit: An edit that identifies and queries entries which are outside of the 

expected range which must be corrected before the record can be filed. 

EBR Electronic Birth Registration System. 

EDR Electronic Death Registration System. 

EFDR Electronic Fetal Death Registration System 

EBR/EDR Edits (both hard and soft) run before the record is transmitted to the state. 

Edit Wherever feasible, edits are to be run at data entry. 

State Edit Edits performed by the state after the record has been transmitted to the 

State. 

Help Menu Instructions to be included as part of the standard help function. 

Instructions 

On Screen Instructions to complete or revise an item which should always appear on 

Instructions the EBR/EDR/EFDR screen. 

Hot key A specific key such as a “?” which can be used to represent unknown 

values for any item. 

Final Review A screen designed to improve data collection by allowing the keyer 

Screen additional time to gather information, and to remind the keyer to complete 

missing information before the record can be filed. Also queries rare 

responses. (See discussion below.) 
GENERAL GUIDELINES, page 3 

4/2004; Updated 3/18/2005 

Bypass A variable that indicates the results of a query for an entry failing an edit. 

Variable The results of the query are in the transmitted data. (See discussion 

below.) 

Missing A variable that provides additional information to an “unknown” 

Value response, e.g., “sought but unknown,” “unobtainable,” and “refused.” 

Variable (See discussion below.) 

 

Processing Variables states will use to collect and process vital statistics data. 

Variables 

Transmission Variables to be transmitted to NCHS as part of the VSCP contract. 

Variables 
GENERAL GUIDELINES, page 4 

4/2004; Updated 3/18/2005 

FINAL REVIEW SCREEN: (EBR/EFDR examples) 

(Also see section on Final Review Screen) 

The final review screen is designed to encourage better reporting of items for which 

necessary information is not immediately available (primarily prenatal care items). The 

keyer is given the option to temporarily skip an item, that is, indicate that data to 

complete the item are not available at the time the record is initiated. The item is then 

placed in pending status and, if not called up and completed beforehand, will appear on 

the final review screen to be completed before the record can be transmitted to the state. 

At the final review screen, the keyer may enter the item information or enter a response 

of “unknown.” 

Once a record has been closed and reopened, the keyer will also have the option to return 

and complete pending items. A list of items still pending will appear on the screen at all 

times after the record is re-opened allowing the keyer to complete the item as information 

becomes available. For example, assume that the keyer has all information on a given 

birth except the mother’s prenatal care data. When the keyer comes to item 6(a) “Date of 

first prenatal care visit,” one of the first items on the facility worksheet, the keyer may 

then indicate that the PNC record is “not yet available,” the item will be skipped and the 

keyer can continue to complete other items on the record. Once the record is re-opened, 

the item “Date of the first prenatal visit” will appear on the pending list to be completed 

at the keyers discretion. If not completed beforehand, the item will appear on the final 

review screen. 

The “pending list” should be available to the keyer at all times after the first re-opening 

of the record, but the final review screen will appear only once, prior to the record being 

sent to the state. The final review screen is also used to query rare item responses such as 

a response of “no prenatal care.” 

BYPASS VARIABLE: 

Bypass variables are used where edits are performed. This variable indicates the 

keyer has been queried about an unexpected response, and has had the opportunity to 

change the response. The use of bypass variables should help reduce queries from the 

state to data providers, and from NCHS to the states. 

MISSING VALUE VARIABLE: 

 The “Missing Value Variable” (MVR) captures responses such as “refused,” “sought 

but unknown,” and “unobtainable," which are intended to expand upon an “unknown” 

response. While not necessary for most variables in the Vital Statistics System, MVRs 

can be useful for items when data are collected directly from an informant. These 
GENERAL GUIDELINES, page 5 

4/2004; Updated 3/18/2005 

responses can then be reviewed by the state to identify data collection issues. The death 

specifications include several items for which several MVR responses are recommended. 
GENERAL GUIDELINES, page 6 

4/2004; Updated 3/18/2005 

THE FINAL REVIEW SCREEN 

Systems should be designed to allow the keyer to temporarily skip items for which 

information/records are not immediately available. This is particularly, but not 

exclusively, applicable to information collected from prenatal care records. 

The “Final Review Screen” is to appear prior to the final transmission of the record for 

those items still “pending.” Such items include any that were marked “pending” as 

above, or those left blank but required to be completed for the record to be filed with the 

state. It also includes items that have failed a hard edit, and selected items with relatively 

rare responses (e.g., “no prenatal care”). 

The following are instructions for the final review screen using “Date of first prenatal 

care visit” and “Date of last prenatal care visit” (items 29(a)&(b)) as examples: 

When items “Date of first prenatal care visit” and “Date of last prenatal care visit” are 

marked “pending” the following screen should appear: 

 

The following item has been marked “pending.” This item must be completed 

before the record is filed. 

Complete ALL PARTS of the dates that are available. 

Leave blank any parts of the dates that are not known. 

Month of the first visit __ __ 

 Day of the first visit __ __ 

 Year of the first visit __ __ __ __ 

Month of the last visit __ __ 

 Day of the last visit __ __ 

 Year of the last visit __ __ __ __ 

 Check this button if all dates are unknown 

 Check this button is there was no prenatal care 

A response of “No prenatal care” on the initial entry screen, also is to be verified at the final review 

screen. (Verification is not necessary for data entered at the State level.) 

 

Please verify whether or not the mother received prenatal care. 

 Yes, the mother received prenatal care 

 No, the mother did not receive prenatal care

If “no prenatal care” is verified, there is no further query for item 29, and item 30 is skipped. 

If the verification response indicates that prenatal care was provided, the following will appear: 
GENERAL GUIDELINES, page 7 

4/2004; Updated 3/18/2005 

Complete ALL PARTS of the dates that are available. 

Leave blank any parts of the dates that are not known. 

Month of the first visit __ __ 

 Day of the first visit __ __ 

 Year of the first visit __ __ __ __ 

Month of the last visit __ __ 

 Day of the last visit __ __ 

 Year of the last visit __ __ __ __ 

 Check this button if all dates are unknown 

 Check this button is there was no prenatal care 

Entry operator must tab through all entry fields. 

If a date is entered, the edits for date are run as indicated in the item 

specification. 

If a date is entered or the “unknown” button is checked, item 30 should be 

completed. 

If no parts of a date are entered after tabbing through the last field, all date fields 

are assigned the “unknown” codes. 
 4/2004; Updated 3/18/2005 

 DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service 

Centers for Disease Control and Prevention 

 

National Center for Health Statistics 

6525 Belcrest Road, Room 1140 

Hyattsville, Maryland 20782 

September 10, 2001 

 (Revised October 29, 2001) 

Dear Colleague: 

Recent meetings with the States and software vendors have demonstrated the need for us to 

clarify NCHS’s position on the data-capturing components of the electronic birth and death 

systems being designed for the upcoming revision. This letter briefly summarizes the NCHS 

guidelines for these systems; more detailed information can be found in the overview of “The 

Specifications for Collecting and Editing The United States Standard Certificates of Birth and 

Death -2003 Revision” and in the specifications for the individual items. The overview and the 

death specifications will be available at our web site soon. We expect to post the finalized birth 

specifications within the next month. 

In order to improve the quality of both State and national vital statistics and to promote 

standardization and comparability among the States, we believe it is essential that all areas 

incorporate certain features into their electronic systems. Data from systems which do not 

include these elements may not be considered comparable to that from systems which do, and 

ultimately may not be included in the national file or in national tabulations. We strongly 

encourage all States which are considering data collection or editing methods which deviate 

from the specifications to consult with us prior to implementation. 

 

We hope to work closely with the software vendors to enhance understanding on both sides of 

data needs and system capabilities and are open to suggestions for ways to improve on these 

elements. We invite all vendors to meet with us within the next few months for more in-depth 

demonstrations and discussion. 

Features integral to the electronic systems: 

• Automatic edits at time of data entry - automatic messages which appear immediately 

after data is entered for a given item. The message alerts the user of data problems (i.e., 

data out of range or inconsistent with other information) and allows the user to 

immediately modify the data. The user should not have discretion as to whether the 

edits are run. There are two types of edits - soft edits which identify and query entries 

but accept the entry upon the users approval, and hard edits which identify and query 

entries which must be corrected before the record can be filed. 
 4/2004; Updated 3/18/2005 

Page 2 - Colleague 

• Ability to edit related items together - the user should be able to readily modify data entered for 

all related items when an edit has identified a problem. For example, if birthweight is found to be 

within the allowable range, but is inconsistent with the (derived) length of gestation, the user 

should be able to readily correct both items since either could be inaccurate. 

 

• Capture of soft-edit query - the system should track when a soft edit has been performed. This 

will allow States to tract frequent edit failures and take corrective action. For selected variables, 

when a soft edit fails a second time, a by-pass variable will be set to alert States and NCHS that the 

out of range value has been verified as correct. 

• On screen messages - the individual item specifications include a number of 

reminders/instructions. A well-designed system should be able to incorporate these messages 

without unduly burdening the user. Not all messages should require action on the part of the user. 

For example, some messages can just be flashed on the screen quickly enough to read. 

• On-line help - definitions and more detailed instructions included in the specifications for both the 

EBC and the EDC, and “The Guide to Completing the Facility Worksheet” for the EBC should be 

available on-line to the user. NCHS expects to make an electronic version of the guide available 

soon. 

• Item order or flow - systems should flow in the same order as the worksheets which were 

designed to encourage information to be gathered from the best sources. (Not applicable to death.) 

• Final review/query screen - systems should be designed to allow the user to temporarily skip 

certain items to allow the user additional time to gather information, especially from the medical 

records. The final query screen reminds the user to complete all missing information and gives them 

the opportunity to do so before the record can be filed or released to the State data file. It also 

queries rare responses, such as a response of “no prenatal care.” Once a record is released to the 

State data file and is accepted by the State, providers should no longer have the ability to modify the 

record. (Not applicable to death.) 

• List of pending items - systems should allow the user to easily access a list of incomplete items 

and go to the incomplete items once a record has been worked on and saved once. Prior to sending 

or finalizing a record, it should be mandatory that the user be presented with a list of all incomplete 

items. 
 4/2004; Updated 3/18/2005 

Page 3 - Colleague 

• For items where it is only correct to choose one response (e.g. Prepregnancy or Gestational Diabetes, or The 

Principal Source of Payment for Delivery) systems should be designed so as to accept only one response. 

Two possible ways to accomplish this are via edit messages or blocking out other response categories after 

one has been selected. 

 

• Version control - systems should include methods to track changes in software versions and notify NCHS of 

version change. Version changes considered necessary to track are ones which include changes to items, edits 

or more substantive changes to tables and format. Each record transmitted to NCHS should have a version 

number. This notice should greatly improve our ability to identify and fix data problems. 

• Cause of death 

- Consistent look for cause of death- On medical examiner, coroner, and physician entry screens, it is 

imperative that the physician viewing the screen be able to see, at minimum, the same prompts and 

formatting as those physicians using the paper version of the death certificate. (Not applicable to 

birth). 

- Additional lines for cause- Additional lines may be added as needed in the cause-of-death statement. 

(Not applicable to birth). 

- Prohibition of pick lists- Physicians completing cause of death must enter medical conditions using 

their own terminology (e.g., pick lists or other mechanisms limiting the choice for cause are not 

allowed). (Not applicable to birth). 

• Electronic death registration system guidelines- The National Association for Public Health Statistics and 

Information Systems' (NAPHSIS) Electronic Death Registration project has created guidelines and associated 

standards (see guidelines and standards at http://www.naphsis.org) for use in developing and implementing an 

electronic death registration system. The NAPHSIS document deals with broad issues while the NCHS 

specifications document deals with individual fields. 

 

This list is intended to address the major issues we have encountered thus far. As we all gain more experience with 

the new systems new issues may arise that will also need to be addressed. We look forward to an ongoing dialogue 

with all parties to work towards the development of the best systems possible. 

For questions or comments on the birth specifications please contact: 

Joyce Martin (301) 458-4362 JAMartin@CDC.GOV 

Stephanie Ventura (301) 458-4547 SVentura@CDC.GOV 
 4/2004; Updated 3/18/2005 

Page 4 - Colleague 

For information on the death specifications: 

Donna Hoyert (301) 458-4279 DHoyert@CDC.GOV 

Ken Kochanek (301) 458-4319 KKochanek@CDC.GOV 

Sincerely yours, 

Mary Anne Freedman 

Director 

Division of Vital Statistics 

 
Item 2, page 1 

 4/2004; Updated 3/18/2005 

Item Title: TIME OF BIRTH (24hr) 

 

Item Number: 2 Certificate, 19 Facility worksheet 

Description: Hour and minute infant was born. 

Source of Information: 

Preferred Source: Labor and delivery, Newborn admission history and 

 physical 

 Other Source: Attendant (non-facility births only) 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Print or type the hour and minute of birth using a 24-hour clock. 

If the time of birth is not known, enter “unknown” in the space. 

Based on the recommendation of the National Institute of Standards and Technology it is 

strongly recommended that the 24-hour clock with the range of 0000-2359 be used. 

0000 is considered the start of the new day. 

TIME OF BIRTH 

(24hr) 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

To report the “Time of Birth” use a 24-hour clock and four digit entry field. 

Hour and minute of birth______________ 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

TB Hour and minute of birth 0000-2359, 

 9999 Unknown 
Item 2, page 2 

 4/2004; Updated 3/18/2005 

 OR 

 0001-2400, (See Edits) 

 9999 Unknown 

 

 

EDITS: 

Based on the recommendation of the National Institute of Standards and Technology it is 

strongly recommended that the 24-hour clock with the range of 0000-2359 be used. 

However, some facilities may use a 0001-2400 range in lieu of the 0000-2359 range. The 

only difference between these systems is in how the beginning of the new day, midnight 

(or 12:00 am using the 12-hour clock) to 59 seconds after midnight (12:00:59 am) is 

represented. For medical facilities the commonly used sequence is: 

2359 (11:59 pm) 

0000 (12:00 am) 

0001 (12:01 am). 

However, for the military (but not necessarily military medical institutions) the sequence 

is: 

2359(11:59 pm) 

2400 (12:00 am) 

0001 (12:01 am). 

The new day begins at 0000 or 2400 (midnight) (0001 = 1 minute after midnight, etc.). 

These latter systems should convert 2400 to 0000 for transmission to NCHS purposes.

ELECTRONIC RECORD 

Before the record is transmitted to the State 

Values must be in the range 0000-2359, 9999 or 0001-2400, 9999. If the value is outside 

the range, an error message should appear showing the invalid value and asking that a 

new value be entered. 

STATE FILE CONSIDERATIONS 

The hour should be recorded using a 24-hour clock. However, States may wish to 

convert the recorded time on the electronic record to the standard 12-hour clock when 

printing paper copies of the certificate for families. 

- For 0000 to 0059 add 1200 hours and “a.m.” 

- For 0100 to 1159 add “a.m.” 

- For 1200 to 1259 add “p.m.” 
Item 2, page 3 

 4/2004; Updated 3/18/2005 

- For 1300 to 2359 subtract 1200 hours and add “p.m.” 

If states elect to use a database system that has an option of storing dates as “date type 

variables,” the system must meet the criteria listed under transmission. 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

 

NAME LENGTH TYPE VALUES 

TB 4 Numeric 0000-2359, 9999 

 

EDI TRANSMISSION: 

HL 7 transmission standards will be followed. This is a time and date stamped standard 

in the following format: 

 [HH[mm]] 

Software that stores dates as “date type” must be year 2000 compliant and capable of 

producing the date in the YYYY..... format and capable of producing messages in the 

HL7 EDI format. 
Item 3, page 1 

 4/2004; Updated 3/18/2005 

Item Title: SEX

Item Number: 3 Certificate, 32 Facility worksheet 

Description: The sex of the infant 

Source of Information:

Preferred Source: Delivery record, Infant’s medical record 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Print or type whether the infant is male, female or if the sex of the infant is not yet 

determined. 

SEX 

________ 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

When the item is to be completed, the following menu should be used to select one 

response: 

 Sex 

 Male 

 Female 

 Not yet determined 

A response of “Not yet determined” on the initial entry screen should be verified at the 

final review screen. 

PROCESSING VARIABLES: 
Item 3, page 2 

 4/2004; Updated 3/18/2005 

NAME DESCRIPTION VALUES DEFINITION

ISEX The sex of the infant M Male 

F Female 

N Not yet determined 

 

EDITS: 

ELECTRONIC RECORD 

Item must be completed. If the record is filed with an N code, send the record to NCHS 

but query the hospital until a determination of the infant’s sex is made. Send the updated 

record to NCHS with the update file 

PAPER RECORD 

Records filed with this field blank or with “not yet determined” are queried. If there is no 

response to the query, retain the “Not yet determined” code. Send the record to NCHS on 

the data file but continue to query until a determination of the infant’s sex is made. The 

revised record should then be sent to NCHS with the updated file. 

 

STATE FILE CONSIDERATIONS 

An N code for “not yet determined” should not be allowed for any record in the file at the 

time the file is closed. NCHS will query states to obtain the sex of the infant for all 

records still retaining the N code at the time the file is closed. 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAME LENGTH TYPE VALUES

ISEX 1 Alpha character string M, F, N 

EDI TRANSMISSION: 

No standards set yet. 
Item 4, page 1 

 4/2004; Updated 3/18/2005 

Item Title: DATE OF BIRTH (INFANT)

Item Number: 4 Certificate, 18 Facility worksheet 

Description: The infant’s date of birth 

Source of Information:

Preferred Source: Labor and delivery, newborn admission history and 

 physical 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Print or type the month, day, and four digit year of birth. Please spell out the month of 

birth. Numeric abbreviations are acceptable for the day and year of birth. 

DATE OF BIRTH (Mo/Day/Yr) 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

The Date of Birth is a three-field entry with the month, day, and year entered in separate 

fields. 

Month of infant’s birth ___ ___ 

Day of infant’s birth ___ ___ 

Year of infant’s birth ___ ___ ___ ___ 

The following instruction should appear in the help function when the infant’s date of 

birth is not known (foundlings). 
Item 4, page 2 

 4/2004; Updated 3/18/2005 

If the date of birth of the infant is not known because the infant is a 

foundling, enter the date the infant was found as the date of birth. 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION 

IDOB_YR Year of Birth 4 digit year Must be equal 

 to current data year 

 

IDOB_MO Month of Birth 01 January 

 02 February 

 03 March 

 04 April 

 05 May 

 06 June 

 07 July 

 08 August 

 09 September 

 10 October 

 11 November 

 12 December 

IDOB_DY Day of Birth 01-31 January 

 01-29 February 

 01-31 March 

 01-30 April 

 01-31 May 

 01-30 June 

 01-31 July 

 01-31 August 

 01-30 September 

 01-31 October 

 01-30 November 

 01-31 December 

 

 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

If month is February and day = 29, year of birth should be a leap year. If not, an error 

message should appear and ask that the date be corrected. 

The infant’s date of birth must be earlier than or the same as the date the record is filed. 
Item 4, page 3 

 4/2004; Updated 3/18/2005 

PAPER RECORD 

For paper records, the same edits are applied at the State level. Edits failed after re-entry 

through the edit screens will result in a listing of items to be queried and the item will be 

given a pending query status. 

STATE FILE CONSIDERATIONS 

While the paper document does not have separate fields for each element of the date, it is 

recommended that the date be entered and stored as three separate fields. 

If states elect to use a database system that has an option of storing dates as “date type 

variables,” then the system must meet the criteria listed under transmission standards. 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

 NAME LENGTH TYPE VALUES

IDOB_YR 4 Numeric or “date Must be equal to 

 type” current data year 

 

IDOB_MO 2 Numeric or “date 01-12 

 type” 

IDOB_DY 2 Numeric or “date 01-31 (based on month) 

 type” 

EDI TRANSMISSION: 

HL 7 Transmission standards will be followed. This is a time date stamped standard in 

the following format: 

 YYYY[MM[DD]] 

Year must be fully represented with four digits. 

Software that stores dates as “date type” must be year 2000 compliant and capable of 

producing the date in the YYYY..... format and capable of producing messages in the 

HL7 EDI format. 
Items 5,6,7,17,26 

Page 1 

4/2004; Updated 3/18/2005 

Item Titles: FACILITY NAME 

 CITY, TOWN OR LOCATION OF BIRTH 

 COUNTY OF BIRTH 

 FACILITY ID (NPI) 

 PLACE WHERE BIRTH OCCURRED

Item Numbers: 5 Certificate, 1 Facility worksheet 

 6 Certificate, 3 Facility worksheet 

 7 Certificate, 4 Facility worksheet 

17 Certificate, 2 Facility worksheet 

 26 Certificate, 5 Facility worksheet 

Descriptions: The name of the facility where the delivery took place 

 The city, town or location of birth 

 The county of birth 

The facility’s National Provider Identification (NPI) or if 

 no NPI, the state hospital code 

 The type of place where the birth occurred 

Source of Information: 

Preferred Source: Admission history and physical, delivery record, 

basic admission data, progress notes 

 Other Source: Attendant (non-facility births only) 

INSTRUCTIONS 

FOR A PAPER RECORD: 

Item 5. 

Type or print the name of the facility where the birth occurred. If this birth did not occur 

in a hospital or freestanding birthing center, please type or print the street and number of 

the place where the birth occurred. If the birth occurred en route, that is in a moving 

conveyance, type or print the city, town, village, or location where the child was first 

removed from the conveyance. If the birth occurred in international air space or waters 

enter “plane” or “boat.” 
Items 5,6,7,17,26 

Page 2 

4/2004; Updated 3/18/2005 

FACILITY NAME (If not institution, give street and number) 

Item 6. 

Type or print the name of the city, town, township, village or other location where the 

birth occurred. If the birth occurred in international waters or air space, enter the 

location where the infant was first removed from the boat or plane. 

CITY, TOWN, OR LOCATION OF BIRTH 

Item 7. 

Type or print the name of the county where the birth occurred. If the birth occurred in 

international waters or air space, enter the name of the county where the infant was first 

removed from the boat or plane. 

COUNTY OF BIRTH 

Item 17. 

Print the facility’s National Provider Identification Number (NPI) or, if no NPI, the state 

hospital code. 

FACILITY ID. (NPI) 

Item 26. 

Please check the box that best describes the type of place where the birth occurred. If the 

type of place is not known, type or print “unknown” in the space. 

PLACE WHERE BIRTH OCCURRED (Check one) 

 Hospital 

 Freestanding birthing center 

 Home Birth: Planned to deliver at home?  Yes  No 

 Clinic/Doctor’s office 

 Other (Specify)_____________ 
Items 5,6,7,17,26 

Page 3 

4/2004; Updated 3/18/2005 

FOR AN ELECTRONIC RECORD: 

EBR Developer: (Instructions are in Italics)

The initial question should ask if the birth occurred in this facility, if the answer is “yes,” or “born en 

route”, all the items (5,6,7,26) and the state facility code should be automatically completed from a table 

look up allowing the keyer to skip these items and move to the next item. 

EBR software should have a table for each facility that contains information about the 

facility, as well as a roster of attendants and certifiers. A mechanism for updating the 

information such as a change in name, status, and the roster is needed. In addition, a 

mechanism for adding and deleting NPI numbers is necessary. 

If the answer is “no,” the following will appear: 

Please check the box below that best describes the type of place where the birth occurred. 

 Hospital 

 Freestanding birthing center 

 Home Birth: 

Planned to deliver at home? 

 Yes 

 No 

 Unknown 

 Clinic/Doctor’s office 

 Other (Specify)_____________ e.g. taxi, train, 

plane 

 Unknown place of birth 

If “Hospital” or “Freestanding birthing center” is checked, the following will appear: 

Name of the facility:_______________________________________ 

If “Home Birth,” or “Clinic/Doctor’s office” is checked, the following will appear: 

Street and Number__________________________________________ 

City, town, or location_______________________________________ 

County__________________________ 

If “Unknown” is checked, all the fields will be filled with the “unknown” code. 
Items 5,6,7,17,26 

Page 4 

4/2004; Updated 3/18/2005 

If the birth occurred en route, that is in a moving conveyance, enter the city, town, 

village, or location where the child was first removed from the conveyance. If the birth 

occurred in an airplane or boat enter boat (lake___) or boat (international waters) etc. 

City, town, or location_______________________________________ 

County__________________________ 

Location________________________ 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

FNAME Name of facility Alpha/numeric 

FNPI Facility NPI number Alpha/numeric 

SFN State facility number Alpha/numeric 

FLOC City town or location of birth Alpha/numeric 

CNAME County name where birth occurred Alpha character string 

CNTYO County code Numeric (Appendix C) 

BPLACE Birthplace 1 Hospital 

2 Freestanding Birthing Center 

3 Home (intended) 

 4 Home (not intended) 

5 Home (unknown if intended) 

6 Clinic/Doctor’s Office 

7 Other 

9 Unknown 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

Valid FIPS codes are assigned to county of birth. If county cannot be located in the 

facility information table, a message should appear indicating the county is not a valid 

county. The message should ask that the spelling be checked and the item re-entered. Or 

a drop down list of counties to choose from could be offered. It is recommended to reenter the county rather than having a drop down menu. 

Place of Birth Item: 

If item is not completed and clerk proceeds to the next item, the item is flagged to be put 

on the list of items needed for completion before the certificate can be filed or printed 

(final review screen). 
Items 5,6,7,17,26 

Page 5 

4/2004; Updated 3/18/2005 

Must be a valid code as indicated above. If “home” is checked and none of the 

subcategories are checked, or “unknown” is checked, the item is assigned the “home 

unknown” code and the following message should appear. 

The record indicates that this birth occurred at home. 

Please query either the attendant or the mother to determine if the mother intended 

to have a home birth. 

Item will be flagged for completion at a later time or at the final review screen. 

Both the home (intended) and home (not intended) boxes cannot be checked. 

PAPER RECORD 

Query if item is not completed. If no response to query, assign the “unknown” code. 

If home delivery is checked but neither the planned at home “yes” or “no” box is 

checked, query. If no response to query, assign the “home (unknown if intended)” code. 

STATE FILE CONSIDERATIONS

It is recommended that states have a 55 character field to maintain the literal entries to 

certificate item 5. In addition, they will need fields for city, town, or location; county, 

and the type of place codes. Only the county codes and type of place codes will be 

transmitted to NCHS. County codes will be assigned immediately by table look up when 

an EBR is completed. City, town and location codes can be handled similarly. For paper 

records it is suggested that the literals be keyed and table look-ups be used for coding. 

For certificate item 26, states may elect to code the “Other (specify)” responses. A 15 

character field to capture the literals and probably a 2 digit field for codes if electing to 

code will be needed. 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAME LENGTH TYPE VALUES

CNTYO 3 Numeric Appendix C 

BPLACE 1 Numeric 1-7, 9 

FNPI 12 Alpha/numeric 

SFN 4 Alpha/numeric 
Items 5,6,7,17,26 

Page 6 

4/2004; Updated 3/18/2005 

EDI TRANSMISSION: 

No standards set yet. 
Item 8b, page 1 

4/2004; Updated 3/18/2005 

Item Title: DATE OF BIRTH (MOTHER)

Item Number: 8b Certificate, 6 Mother’s worksheet 

Description: The mother’s date of birth 

Source of Information:

Preferred Source: Mother 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Print or type the month (spelled out), day, and four-digit year of birth. 

If the mother’s Date of Birth is unknown, then print “unknown.” If part of Date of Birth 

is unknown, enter the known parts and leave the remaining parts blank. 

DATE OF BIRTH (Mo/Day/Yr) 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

The Date of Birth item is a three-field entry with the month, day, and year entered in 

separate fields. 

When the item is to be completed, the following message should appear at the top of the 

screen and remain on the screen until the last field of the date is completed: 

If only part of the Mother’s date of birth is known, enter all parts that are 

known and leave the unknown parts blank. 

If the date of birth of the mother is not known at this time, leave blank. 

Month of mother’s birth ___ ___ 

Day of mother’s birth ___ ___ 
Item 8b, page 2 

4/2004; Updated 3/18/2005 

Year of mother’s birth ___ ___ ___ ___ 

If the date of birth is not known at this time, the item will be pended and will appear on 

the final review screen. 

Any fields left blank will be filled with 9’s. (Alternatively, “hot keys” for unknown 

numeric values may be used in place of leaving values blank.) 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION 

MDOB_YR Year of Birth 4 digit year Must be less than 

 child’s year of birth 

 9999 Unknown 

MDOB_MO Month of Birth 01 January 

02 February 

03 March 

04 April 

05 May 

06 June 

07 July 

08 August 

09 September 

10 October 

11 November 

12 December 

 

99 Unknown 

MDOB_DY Day of Birth 01-31 January 

 01-29 February 

 01-31 March 

 01-30 April 

 01-31 May 

 01-30 June 

 01-31 July 

 01-31 August 

 01-30 September 

 01-31 October 

 01-30 November 

 01-31 December 

99 Unknown 

MAGE_CALC Calculated age 00-98 
Item 8b, page 3 

4/2004; Updated 3/18/2005 

99 Unknown 

MAGE_BYPASS 0 Off 

 1 On (data queried) 

 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

All blank fields will be converted to all 9’s. 

If month is February and day = 29, year of birth should be a leap year. If not, an error 

message should appear and ask that the date be corrected. 

Age is calculated using mother’s date of birth (completed dates only) and the child’s date 

of birth. 

Calculated age must be >8 and < 65. 

If age is outside this range a message appears that reads: 

Mother’s age is out of acceptable limits, please check the mother’s date of birth and 

re-enter the date of birth. 

The entry screen for the mother’s date of birth appears. 

Age is recalculated and if still outside the acceptable limits the MAGE_BYPASS variable 

is set to ON-1

PAPER RECORD 

Records filed with no age of mother are queried. For those records with stated “age of 

mother” the same edits described above are applied. Failed edits are to be queried. 

STATE FILE CONSIDERATIONS 

While the paper document does not have separate fields for each element of the date, it is 

recommended that the date be entered and stored as three separate fields. 

If states elect to use a database system that has an option of storing dates as “date type 

variables,” then the system must meet the criteria listed under transmission standards. 
Item 8b, page 4 

4/2004; Updated 3/18/2005 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

 NAME LENGTH TYPE VALUES

MDOB_YR 4 Numeric or “date 4 digit year, <child’s yr of birth, 9999 

 type” 

 

MDOB_MO 2 Numeric or “date 01-12, 99 

 type” 

MDOB_DY 2 Numeric or “date 01-31 (based 

 type” on month), 99 

 

MAGE_BYPASS 1 Numeric 0,1 

 

EDI TRANSMISSION: 

HL 7 Transmission standards will be followed. This is a time date stamped standard in 

the following format: 

 YYYY[MM[DD]] 

Year must be fully represented with four digits. Software that stores dates as “date type” 

must be year 2000 compliant and capable of producing the date in the YYYY..... format 

and capable of producing messages in the HL7 EDI format. 
Item 8d, page 1 

4/2004; Updated 3/18/2005 

Item Title: BIRTHPLACE (STATE, TERRITORY, OR 

FOREIGN COUNTRY)

Item Number: 8d Certificate, 7 Mother’s worksheet

Description: The geographic location of the mother’s place of birth. 

Source of Information: 

 Preferred Source: Mother or other informant 

INSTRUCTIONS 

FOR A PAPER RECORD: 

Print or type the name of the U.S. State or U.S. Territory in which the mother was born. 

If the mother was born outside of the U.S., print or type the name of the country in which 

the mother was born. U.S. territories are: Puerto Rico, U.S. Virgin Islands, Guam, 

American Samoa, and Northern Marianas. If the mother’s birthplace is not known, print 

or type “Unknown” in the space. (NOTE: Canadian Provinces and Canadian Territories 

are not individually identified for mother’s place of birth) 

BIRTHPLACE (U.S. State, U.S. Territory, or Foreign Country) 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

There should be a screen with separate entry spaces each for state, territory, and country 

of birth. The series of items to be captured with instructions is suggested below. 

Birthplace of Mother 

(Please enter for only one field) 

Mother’s U.S. State of Birth ___________________ 

OR 

Mother’s U.S. Territory of Birth _________________ 
Item 8d, page 2 

4/2004; Updated 3/18/2005 

OR 

Mother’s Country of Birth________________ (if born outside of the U.S.) 

 Mother’s birthplace unknown 

If unknown is recorded on the worksheet or if the informant does not know, check the 

“Mother’s birthplace unknown” box. 

 

As soon as an acceptable entry is made in any one of the fields, the screen moves on to 

the next item on the worksheet to avoid entries in more than one birthplace field. 

“Incremental browsing” may be used to facilitate quicker selection of the mother’s 

birthplace. Incremental browsing refers to the process in which the keyer enters the first 

or so letter of the state, territory or country and the system automatically presents the 

list of places beginning with that letter(s). The keyer then can more readily select the 

correct locale without typing in the rest of the word. For example, for the Mother’s 

country of birth, when the keyer enters the letter “C “ the system would automatically go 

to where “Cambodia” is on the list. If the keyer enters the letters “Ch,” the system 

would automatically go to where “Chad” is on the list. 

 

PROCESSING VARIABLES: 

 NAME DESCRIPTION VALUES 

 

BPLACE_ST Mother’s state of birth (literal) Literal entry, blank 

BPLACE_TER Mother’s territory of birth (literal) Literal entry, blank 

BPLACE_CNT Mother’s country of birth (literal) Literal entry, blank 

BPLACEC_ST_TER Code for Mother’s state or territory of birth Appendix B 

BPLACEC_CNT Code for Mother’s country of birth Appendix A 

TRANSLATIONS: 

Literal entries for U.S. States and U.S. Territories must be converted to FIPS 5-2, two 

character codes (Appendix B). 

Literal entries for U.S. States and U.S. Territories must be combined to a single field 

(BPLACEC_ST_TER) when coded. 

Literal entries for countries must be coded two character FIPS10-4 codes for countries 

(Appendix A). 

If the “ unknown” box is checked, the value ZZ is assigned to all fields. 
Item 8d, page 3 

4/2004; Updated 3/18/2005 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

Entries in all fields transmitted to NCHS must be valid FIPS codes or ZZ (Appendix A 

and B). 

If there is an entry in the U.S. State/Territory field other than ZZ, country and unknown 

fields must be blank. 

If there is an entry in the country field other than ZZ, the U.S State/Territory and 

unknown fields must be blank. 

If there is an entry in either field other than ZZ, the unknown field must be blank. 

STATE FILE CONSIDERATIONS 

Suggested field names are: 

 

 State of birth BPLACE_ST_TER 

Country of birth BPLACE_CNT 

A field length of 30 characters for each field is suggested. 

States may also opt to retain coded fields as well as the literal entries. If coded fields are 

maintained as well, there are HISSB standards that should be used. Literals for countries 

should be assigned codes using two character FIPS 10-4 codes (Appendix A). 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

 NAME LENGTH TYPE VALUES

BPLACEC_ST_TER 2 Alphabetic Appendix B 

BPLACEC_CNT 2 Alphabetic Appendix A 

EDI TRANSMISSION: 

No standards set yet. 

 
Item 9, page 1 

4/2004; Updated 3/18/2005 

Item Title: RESIDENCE OF MOTHER: 

STATE 

 COUNTY 

 CITY, TOWN OR LOCATION 

 STREET AND NUMBER 

 APT. NO. 

 ZIP CODE 

 INSIDE CITY LIMITS? 

Item Number: 9a – 9g Certificate; 3, 4 Mother’s worksheet 

Description: The geographic location of the mother’s residence 

Source of Information:

Preferred Source: Mother or other informant 

INSTRUCTIONS: 

FOR A PAPER RECORD: 

 

Items 9a-9g. 

These items refer to the mother’s residence address, not her postal address. Do not 

include post office boxes or rural route numbers. 

Item 9a. 

This item is where the U.S. States and territories, and the provinces of Canada are 

recorded. 

If the mother is a U.S. resident, print the U.S. State or territory where the mother lives. 

If the mother is a U.S. resident do not record “U.S.” 

If the mother is a Canadian resident, print the name of the province or territory followed 

by “ / Canada.” 

If the mother is not a resident of the U.S., its territories, or Canada, print the name of the 

mother’s country of residence. 

RESIDENCE OF MOTHER-STATE 
Item 9, page 2 

4/2004; Updated 3/18/2005 

Item 9b & 9c. 

Print the county, city or town or location where the mother lives. 

If the mother is not a U.S. resident, leave these items blank. 

COUNTY CITY, TOWN, OR LOCATION 

Items 9d-9f. 

Print the mother’s street name and number, apartment or room number, and zip code. 

If the mother is not a U.S. resident, leave these items blank. 

For the street name, be sure to include any prefixes, directions and apartment numbers. 

Examples: South Main Street 

Walker Street NW

STREET AND NUMBER APT. NO. ZIP CODE 

Item 9g. 

Check whether the mother’s residence is inside of city or town limits. 

If it is not known if the residence is inside the city limits, print “unknown.” 

If the mother is not a U.S. resident, leave this item blank. 

INSIDE CITY LIMITS? 

 Yes  No 

 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics) The collection of the mother’s residence 

data should be set up to maximize the efficient use of GIS coding technology in order to 

improve the geographic allocation of these events. Two options for recording the street 

address are provided. In the second option, the street address will have to be parsed to 

separate out the pre- and post-directionals. Space in the State data files for the extended 

zip codes, latitude and longitude coordinates and centroids will have to be allowed. 

PREFERRED METHOD: 

If the “street” name has a direction as a prefix, enter the prefix in the space labeled 

“pre-directional”. If the “street” name has a direction after the name, enter the suffix in 

the space labeled “post-directional.” 

Examples: South Main Street. Enter the name as Main and the pre- 

 direction as South. 
Item 9, page 3 

4/2004; Updated 3/18/2005 

Walker Street NW. Enter the name as Walker and NW in the 

post-directional space. 

If there are no pre- or post-directions, leave these spaces blank. 

OPTIONAL ACCEPTABLE METHOD I: 

If the “street” name has a direction as a prefix, enter the prefix in front of the street 

name. If the “street” name has a direction after the name, enter the direction after the 

name. 

Examples: South Main Street. Enter the name as South Main. 

Walker Street NW. Enter the name as Walker NW. 

While all the residence fields are being completed, the following general instructions 

should be on the screen. 

• Residence of the mother is the place the mother actually resides. 

• Do not report temporary residences such on a visit, business trip, or 

vacation. 

• Place of residence during a tour of military duty or attendance at college 

should be entered as the place of residence. 

• For mothers who live in a group home, mental institution, penitentiary, 

or hospital for the chronically ill, report the location of the facility as the 

place of residence. 

• Enter all of the address that is known. For example, a homeless woman 

could only have a city, county and state entered. 

Data entry should be set up in the order identified below. When each item is to be 

completed specific instructions will appear. These are listed below. 

1. Building number_______ 

2. Pre-directional_______________________ 

 3. Name of the “street”__________________ 

 4. Street designator e.g., street, avenue, etc. ______________ 

 5. Post-directional ______________ 

 6. Apartment or room number______________ 

 7. Name of the city, town, or other place of residence_____________ 

 8. County of the mother’s residence________________ 

9. U.S. State, U.S. Territory, or Canadian Province of the residence _______ 

10. Zip code of the above address (either 5 or 9 digits)__________________ 

11. Mother’s country of residence_________________ 

The inside city limits question will appear only if the “Mother’s country of residence” is 

USA, and “Name of city, town, or other place of residence is not “unknown.” 

12. Is mother’s place of residence inside the city or town limits? 
Item 9, page 4 

4/2004; Updated 3/18/2005 

 Yes 

 No 

 Unknown 

 

 

When item 1 “Building number” is to be completed, the following instructions should 

appear: 

Enter the building number assigned to the mother’s residence. 

 Do not record a R.R. number or P.O. box. 

 If the number is unknown, enter “unknown.” 

When item 2 “Pre-directional” is to be completed, the following instructions should 

appear. 

If the “street” name has a direction as a prefix, enter the prefix in the space 

labeled “pre-directional.” 

Example: South Main Street. Enter the predirection as South. 

If there is no pre-direction, leave this space blank. 

When item 3 “Street name” is to be completed, the following instructions should appear. 

Enter the “street” name of the mother’s residence. 

 Do not enter a R.R. number. 

When item 4 “Street designator” is to be completed, the following instruction should 

appear. 

Enter the street designator. 

Examples of the street designators are words like Street, Avenue, Road, 

Circle, Court etc. 

When item 5 “Post directional” is to be completed, the following instructions should 

appear. 

If the “street” name has a direction after the name, enter the suffix in the 

space labeled “post-directional.” 

Example: Walker Street NW. Enter NW in the post-directional space. 
Item 9, page 5 

4/2004; Updated 3/18/2005 

 If there is no post-direction, leave this space blank. 

When item 6 “Apartment number” is to be completed, the following instruction should 

appear. 

If there is no apartment or room number associated with this residence, leave 

the item blank. 

When item 7 “Name of city or town” is to be completed, no instructions are needed. 

When item 8. “County of residence” is to be completed, the following instruction should 

appear. 

If the mother resides in any country other than the U.S. or its Territories, 

leave this item blank. 

When item 9. “U. S. State, U.S. territory, Canadian province, or Canadian Territory” is 

to be completed, the following instructions should appear. 

Enter the U.S. State or U.S. territory. 

If the mother resides in a Canadian province or Canadian territory, enter the 

name of the province or territory. 

When item 10 “Zip code” is to be completed, the following instruction should appear. 

If only the 5 digit Zip code is known, report that. 

If the mother is not a resident of the U.S. or its territories, leave this item 

blank. 

When item 11 “Country of residence” is to be completed, the following instructions 

should appear. 

If a valid U.S. State or U.S. territory was entered in the previous item, 

“United States” will automatically be entered. 

If a valid Canadian province or Canadian territory was entered in the 

previous item, “Canada” will automatically be entered. 
Item 9, page 6 

4/2004; Updated 3/18/2005 

If the mother is not a resident of the U.S., its territories, or Canada, enter the 

name of the mother’s country of residence. 

If the mother’s country of residence is unknown, enter “unknown.” 

When item 12. “Inside city limits” is to be completed, the following instruction should 

appear. 

If uncertain if the residence is inside the city or town limits, check the 

“unknown” box. 

OR (Alternate Format II) 

1 Building number_______ 

 2. Name of the “street”__________________ 

 3. Street designator e.g., street, avenue, etc. ______________ 

 4. Apartment or room number___________ 

5. Name of the city, town, or other place of residence_____________ 

6. County of the mother’s residence________________ 

 7. U.S. State, U.S. Territory, or Canadian Province of the residence _______ 

8. Zip code of the above address (either 5 or 9 digits)__________________ 

9. Mother’s country of residence_________________ 

The inside city limits question will appear only if the “Mother’s country of residence” is 

USA, and “Name of city, town, or other place of residence is not “unknown.” 

10. Is mother’s place of residence inside the city or town limits? 

 Yes 

 No 

 Unknown 

 

Instructions for the optional method: 

When item 1 “Building” is to be completed, the following instructions should appear. 

Enter the street number assigned to the mother’s residence. 

 Do not record a R.R. number or P.O. box. 

 If the number is unknown, enter “unknown.” 

When item 2 “Name of street” is to be completed, the following instructions should 

appear. 

Enter the “street” name of the mother’s residence. 
Item 9, page 7 

4/2004; Updated 3/18/2005 

 Do not enter a R.R. number. 

If the “street” name has a direction as a prefix, enter the prefix in front of 

the street name. If the “street” name has a direction after the name, enter the 

direction after the name. 

Examples: South Main Street. Enter the name as South Main. 

Walker Street NW. Enter the name as Walker NW. 

When item 3 “Street designator” is to be completed, the following instruction should 

appear. 

Enter the street designator. 

Examples of the street designator are words like Street, Avenue, Road, 

Circle, Court, etc. 

When item 4 “Apartment number” is to be completed, the following instruction should 

appear. 

If there is no apartment or room number associated with this residence, leave 

the item blank. 

When item 5 “City or town” is to be completed, no instructions are needed. 

When item 6 “County of residence” is to be completed, the following instruction should 

appear. 

If the mother resides in any country other than the U.S. or its territories, 

leave this item blank. 

When item 7 “State, U.S. territory, or Canadian province” is to be completed, the 

following instructions should appear. 

Enter the U.S. State or U.S. territory. 

If the mother resides in a Canadian province or Canadian territory, enter the 

name of the province or territory. 

When item 8 “Zip code” is to be completed, the following instruction should appear. 

 

If only the 5 digit Zip code is known, report that. 
Item 9, page 8 

4/2004; Updated 3/18/2005 

If the mother is not a resident of the U.S. or its territories, leave this item 

blank. 

When item 9 “Country of residence” is to be completed, the following instructions should 

appear. 

If a valid U.S. State or U.S. territory was entered in the previous item, 

“United States” will automatically be entered. 

If a valid Canadian province or Canadian territory was entered in the 

previous item, “Canada” will automatically be entered. 

If the mother is not a resident of the U.S., its territories, or Canada, enter the 

name of the mother’s country of residence. 

If the mother’s country of residence is unknown, enter “unknown.” 

When item 10 “Inside city limits” is to be completed, the following instruction should 

appear. 

If uncertain if the residence is inside the city or town limits, check the 

“unknown” box. 

PROCESSING VARIABLES:

NAME DESCRIPTION VALUES DEFINITION

STNUM Street number 

PREDIR Pre-directional 

STNAME Street name 

STDESIG Street designator 

POSTDIR Post-directional 

UNUM Unit or apartment number 

CITY City or Town name 

CITYC City or Town code See Appendix C 

ZIP Zip Code 

COUNTY County 

COUNTYC County code See Appendix C 

STATE State/Province 

STATEC State/Province code See Appendix B 

COUNTRY Country 

COUNTRYC Country code See Appendix A 

LIMITS Inside city limits Y Yes 

 N No 

 U Unknown 

TRANSLATIONS 
Item 9, page 9 

4/2004; Updated 3/18/2005 

Response Mapping (examples) 

 Response Maps to values

Country Name Appendix A to be superseded by 

NCHS Part 8A 

FIPS10-4 two character codes

State/Province Name Appendix B to be superseded by 

NCHS Part 8A 

FIPS 5-2 two character codes or 

Canadian two character postal codes

City/Town Name Appendix C to be superseded by 

NCHS Part 8A 

FIPS 55-3 five digit place codes 

County Name Appendix C to be superseded by 

NCHS Part 8A 

FIPS 6-4 three digit County codes 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

1. If country is unknown, then city, county and State may also be unknown. Do not run 

any table look-ups for city, county or State. 

2. If country is known and is not the U.S. or Canada, then city, county, and 

State/Province may be blank. 

3. If country is Canada, city and county may be blank, but run table look-ups for 

State/Province. 

The Province is checked against Canadian Postal Codes (Appendix B). If not in table 

and if it is an electronic record, a message should appear asking that the name be 

checked. Enter revised data; if edit fails again, code Province to “unknown.” Keep 

literal. For a paper record, automatically reject and follow-up with the hospital. If 

rejected a second time, code Province to “unknown.” 

4. If country is the U.S., run table look-ups for State/Province, County, and city. 

State is checked in FIPS 5-2. If not in table and if it is an electronic record, a 

message should appear asking that the name be checked. Enter revised data; if edit 

fails again, code State to “unknown.” Keep literal. For a paper record, automatically 
Item 9, page 10 

4/2004; Updated 3/18/2005 

reject and follow-up with the hospital. If rejected a second time, code State to 

“unknown.” 

The city name is checked in FIPS 55-3 name table. If not in table and if it is an 

electronic record, a message should appear asking that the name be checked. Enter 

revised data; if edit fails again, code city to “unknown.” Keep the literals. For a 

paper record, automatically reject and follow-up with the hospital. If rejected a 

second time, code city to “unknown.” 

Code County using FIPS 6-4. If not in table, then reject record for review and/or 

follow-up. If electronic record, reject at hospital. Error message should indicate that 

the county is not listed, please check and re-enter. Record cannot be printed or filed 

without a county entered.

STATE FILE CONSIDERATIONS 

If all components of residence are unknown, use place of occurrence as place of 

residence for statistical purposes. States may wish to keep the record unknown for legal 

files. It is recommended that States keep this information in as detailed a format as 

possible. See the recommended electronic format below. For data collected on paper 

records, keying instructions need to reflect the detail of the electronic record. If States 

elect to use GIS on these data then space in the State data file will be needed for the 

derived variables of latitude, longitude, centroid and extended nine-digit zip code. 

ELECTRONIC RECORD 

For the purpose of recording and printing certified copies from the electronic file and for 

geo-coding the record, it is recommended that the address field be separated into fields as 

described below. These fields generally correspond to the CDC, HISSB 

recommendations. However, the field lengths do not correspond to the recommendations 

because the literal entries need to be captured. If a State desires, the literal entries can be 

transposed to abbreviations for purposes of compacting the file using standard 

abbreviations as recommended in the HISSB standards. States may wish to collect Zip 

code to the ninth digit when known rather than just five. 

Suggested field names are: 

DESCRIPTION NAME LENGTH

Street number STNUM 10 

Pre-directional PREDIR 10 

 Street name STNAME 28 

 Street designator STDESIG 10 

 Post-directional POSTDIR 10 
Item 9, page 11 

4/2004; Updated 3/18/2005 

 Unit or apartment number UNUM 7 

 City or Town name CITY 28 

 Zip Code ZIP 9 

 County COUNTY 28 

 State/Province STATE 28 

 Country COUNTRY 28 

States may also opt to retain coded fields as well as the literal entries. If coded fields are 

maintained as well, there are HISSB standards that should be used. Literals for 

countries should be assigned codes using FIPS 10-4 using the two character codes for 

nations (Appendix A). County should be coded using three digit FIPS 6-4codes 

(Appendix C). City of residence should be transmitted to NCHS using FIPS 55-3 five 

digit codes (Appendix C). State/Province should be coded using two character codes and 

Canadian postal codes, see Appendix B). 

Note that new FIPS 10-4 tables are issued regularly. As new FIPS 10-4 tables are 

issued, new codes should be added, but do not replace existing codes. The old codes are 

needed for consistency. 

NCHS TRANSMISSION FILE 

States that elect to use a GIS coding process prior to submission of data to NCHS shall 

replace the codes for city, town, or other place as well as county codes with those derived 

from the GIS process. 

VARIABLES: 

NAME LENGTH TYPE VALUE

CITYC City/Town 5 Numeric Appendix C 

COUNTYC County 3 Numeric Appendix C 

STATEC State/Province 2 Alpha Appendix B 

COUNTRYC Country 2 Alpha Appendix A

LIMITS 1 Alpha Y,N,U 

EDI TRANSMISSION: 

No standards set yet. 

 
Item 10b, page 1 

4/2004; Updated 3/18/2005 

Item Title: DATE OF BIRTH (FATHER)

Item Number: 10b Certificate, 19 Mother’s worksheet 

Description: The father’s date of birth 

Source of Information:

Preferred Source: Mother or father

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Print or type the month, day, and four-digit year of birth. 

If the father’s Date of Birth is unknown, print “unknown.” If part of the Date of Birth is 

unknown, enter the known parts and leave the remaining parts blank. 

DATE OF BIRTH (Mo/Day/Yr) 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

The Date of Birth item is a three-field entry with the month, day, and year entered in 

separate fields. 

When the item is to be completed, the following message should appear at the top of the 

screen and remain on the screen until the last field of the date is completed: 

Enter all parts of the father’s date of birth that are known. Leave the 

unknown parts blank. If the entire date of birth of the father is not known, 

leave all fields blank. 

The date of birth is a three-field entry. 

Month of father’s birth ___ ___ 

Day of father’s birth ___ ___ 

Year of father’s birth ___ ___ ___ ___ 
Item 10b, page 2 

4/2004; Updated 3/18/2005 

As an alternative to leaving unknown values blank, “hot keys” may be used. 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION 

FDOB_YR Year of Birth 4 digit year Must be less the 

 child’s date of birth 

 9999 Unknown 

FDOB_MO Month of Birth 01 January 

02 February 

03 March 

04 April 

05 May 

06 June 

07 July 

08 August 

09 September 

10 October 

11 November 

12 December 

99 Unknown 

FDOB_DY Day of Birth 01-31 January 

 01-29 February 

 01-31 March 

 01-30 April 

 01-31 May 

 01-30 June 

 01-31 July 

 01-31 August 

 01-30 September 

 01-31 October 

 01-30 November 

 01-31 December 

99 Unknown 

FAGE_CALC Calculated age 00-98 

99 Unknown 

FAGE_BYPASS 0 Off 

 1 On (data queried) 
Item 10b, page 3 

4/2004; Updated 3/18/2005 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

All blank fields will be converted to all 9’s. 

If month is February and day = 29, year of birth should be a leap year. If not, an error 

message should appear and ask that the date be corrected. 

Age is calculated using father’s date of birth (completed dates only) and the child’s date 

of birth. 

Calculated age must be >8 and < 75. 

If age is outside this range a message appears that reads: 

Father’s age is out of acceptable limits, please check the father’s date of birth and 

re-enter the date of birth. 

The entry screen for the father’s date of birth appears. 

Age is recalculated and if still outside the acceptable limits the FAGE_BYPASS variable 

is set to ON-1

PAPER RECORD 

For paper records, the same edits are applied. 

STATE FILE CONSIDERATIONS 

While the paper document does not have separate fields for each element of the date, it is 

recommended that the date be entered and stored as three separate fields. 

If states elect to use a database system that has an option of storing dates as “date type 

variables,” then the system must meet the criteria listed under transmission standards. 

NCHS TRANSMISSION FILE 

 

VARIABLES: 
Item 10b, page 4 

4/2004; Updated 3/18/2005 

 NAME LENGTH TYPE VALUES

FDOB_YR 4 Numeric or “date 4 digit year <Year of birth, 9999 

 type” 

 

FDOB_MO 2 Numeric or “date 01-12, 99 

 type” 

FDOB_DY 2 Numeric or “date 01-31 (based 

 type” on month), 99 

 

FAGE_BYPASS 1 Numeric 0,1 

 

EDI TRANSMISSION: 

HL 7 Transmission standards will be followed. This is a time date stamped standard in 

the following format: 

 YYYY[MM[DD]] 

Year must be fully represented with four digits. Software that stores dates as “date type” 

must be year 2000 compliant and capable of producing the date in the YYYY..... format 

and capable of producing messages in the HL7 EDI format. 
Item 15, page 1 

4/2004; Updated 3/18/2005 

Item Title: MOTHER MARRIED? 

Item Number: 15 Certificate; 15, 17 Mother’s worksheet

 

Description: The marital status of the mother at birth, conception or 

any time in between. 

Source of Information: 

Preferred Source: Mother 

 Other Source: Informant

INSTRUCTIONS 

FOR A PAPER RECORD: 

If the mother is currently married or married at the time of conception or any time 

between conception and birth, check the “Yes” box. 

If the mother is not currently married or was not married at the time of conception or any 

time between conception and birth, check the “No” box. 

If the “No” box is checked, and an acknowledgement of paternity has been signed in the 

hospital, check the “Yes” box for the acknowledgement of paternity. Otherwise check the 

“No” box. 

MOTHER MARRIED? (At birth, conception, or any time between) 

 Yes  No 

IF NO, HAS PATERNITY ACKNOWLEDGEMENT BEEN SIGNED IN THE 

HOSPITAL?

 Yes  No 

FOR AN ELECTRONIC RECORD: 

EBR developer: (Instructions are in italics) 

There are a series of questions required by this item: 

A. Has the mother ever been married? 

 Yes 
Item 15, page 2 

4/2004; Updated 3/18/2005 

 No 

 Unknown at this time 

If the “Yes” box is checked, the screen for the mother’s name prior to first marriage is 

shown. (See item 8c.) Once this is completed, question B appears. 

If the “No” box is checked, B is skipped and question C appears. 

If the “Unknown at this time” box is checked, all variables are assigned the “unknown” 

code, questions B and C are skipped and the following message will appear: 

Please contact the mother, if she is still in the facility, to obtain this information. The item 

will appear on the final review screen. 

 B. Was the mother married at the time she conceived this child, at the time of birth, or at 

any time between conception and giving birth? 

 Yes 

 No 

If the “Yes” box is checked, the EBR should then request the information about the father 

(items 10a, 10b, 10c, 19, 23, 24, 25). 

If the no box is checked question C appears, 

C. Have the mother and father signed a form (Insert name of the State 

acknowledgement of paternity form) in which the father accepted legal 

responsibility for the child? 

 Yes, a paternity acknowledgement has been completed 

 No, a paternity acknowledgement has not been completed. 

If the “Yes” box is checked, the EBR must request the information about the father (items 

10a, 10b, 10c, 19, 23, 34, 25). 

If the “No” box is checked, all items about the father (items 10a, 10b ,10c, 19, 23, 24, 25) 

are skipped. 

PROCESSING VARIABLES: 

 

NAME DESCRIPTION VALUES DEFINITION

MARE Mother ever married Y Yes 

N No 

 U Unknown 

MARN Mother married at Y Yes 

conception, at birth or N No 
Item 15, page 3 

4/2004; Updated 3/18/2005 

any time in between U Unknown 

 

ACKN Acknowledgement of Y Yes 

paternity signed N No 

 X Not applicable 

U Unknown 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

Each variable must have a response. 

If the variable MARE has value “N”, the value “N” is assigned to variable MARN. 

If the variable MARN has value “Y,” the variable ACKN is assigned “X,” unless state 

law allows an acknowledgement in such cases. 

If the variable MARN has value “Y” or the variable ACKN has value “Y” items 10a, 

10b, 10c, 19, 23 24 and 25 should have entries. 

If the variable MARN has value “N” and the variable ACKN has value “N”, items 10a, 

10b, 10c, 19, 23 24, and 25 must be blank. 

PAPER RECORD 

Records filed with the “Mother married” item blank should be queried. If no response to 

query, assign the “unknown” code to all variables. 

If the “Yes” box for married now, at conception, or any time in between is checked, the 

acknowledgement of paternity box must be blank or checked “No.” (Specific state law 

may change this specification; for example, court orders prior to the birth of the child to a 

married woman.) 

State Edits of data file prior to NCHS transmission 

See above edits for electronic records. 

STATE FILE CONSIDERATIONS 

States may need to adjust this item to meet State legal requirements. If states have an 

electronic paternity acknowledgement, the answers to these questions can be used to 

drive the creation of the acknowledgement and data from the birth record used to 

populate the acknowledgement. If an electronic acknowledgement is created and signed 

first, these data can be used to populate the birth record(s). 
Item 15, page 4 

4/2004; Updated 3/18/2005 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAME LENGTH TYPE VALUES

MARE 1 Alpha character string Y, N, U 

MARN 1 Alpha character string Y, N, U 

ACKN 1 Alpha character string Y, N, X, U 

 

EDI TRANSMISSION: 

No standards set yet. 

 
Item 20, page 1 

4/2004; Updated 3/18/2005 

 

Item Title: MOTHER’S EDUCATION

Item Number: 20 Certificate; 8 Mother’s worksheet

Description: The highest degree or level of schooling completed by 

the mother at the time of this delivery

Source of Information:

Preferred Source: Mother or other informant 

INSTRUCTIONS 

FOR A PAPER RECORD: 

Based on the mother’s response to the worksheet or interview, check the appropriate box 

on the certificate. If the mother leaves the item blank on the worksheet and she is still in 

the facility, query. If the mother has left the facility write “Unknown” in the space. 

MOTHER’S EDUCATION 

(Check the box that best describes the highest degree or level of school completed at the 

time of delivery) 

 8th grade or less 

 9th-12th grade; no diploma 

 High school graduate or GED completed 

 Some college credit, but not a degree 

 Associate degree (e.g. AA, AS) 

 Bachelor’s degree (e.g. BA, AB, BS) 

 Master’s degree (e.g. MA, MS, MEng, MEd, MSW,MBA) 

 Doctorate (e.g. PhD, EdD) or Professional degree (e.g. MD, DDS, DVM, LLB, 

JD) 
Item 20, page 2 

4/2004; Updated 3/18/2005 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

Mother’s education level is chosen from the list below and the instructions should appear 

when the item is to be completed. 

Mother’s Education 

Based on the mother’s response to the worksheet or interview, check the 

category that best describes the highest degree or level of school completed. 

 8th grade or less 

 9th-12th grade; no diploma 

 High school graduate or GED completed 

 Some college credit, but not a degree 

 Associate degree (e.g. AA, AS) 

 Bachelor’s degree (e.g. BA, AB, BS) 

 Master’s degree (e.g. MA, MS, MEng, MEd, MSW, 

MBA) 

 Doctorate (e.g. PhD, EdD) or Professional degree 

(e.g. MD, DDS, DVM, LLB, JD) 

 Unknown 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

MEDUC 1 8th grade or less 

2 9th through 12th grade; no 

diploma 

3 High school graduate or GED 

completed 

4 Some college credit, but not a 

degree 

5 Associate degree (e.g., AA, 

AS) 

6 Bachelor’s degree (e.g., BA, 

AB, BS) 

7 Master’s degree (e.g., MA, 

MS, MEng, Med, MSW, 

MBA) 
Item 20, page 3 

4/2004; Updated 3/18/2005 

8 Doctorate degree (e.g., PhD, 

EdD) or professional degree 

(e.g., MD, DDS, DVM, LLB, 

JD) 

9 Unknown 

MEDUC_BYPASS 0 OFF (default value, edit 

passed) 

1 ON (edit failed, data queried 

and verified) 

2 ON (edit failed, data queried 

and not verified) 

EDITS: 

ELECTRONIC RECORD

Before the record is transmitted to the State 

If the “Unknown” box is checked the following message should appear: 

If the mother is still in the facility, please obtain her education level. If the mother 

has left the facility, please check the box below. 

 Mother has left the facility 

If the box is checked the item is not pended and will not appear on the final review 

screen. 

At the time of input to an EBR or electronic work sheet, Mother’s date of birth will have 

been entered and edited. Mother’s age at the time the worksheet is completed will be 

calculated and stored as a variable for the purposes of this edit. 

If age/education edit indicates a discrepancy, the education information needs to be 

reviewed. 

Valid codes 1-9 (See processing variables for detail) 

 Values Minimum Age 

 

1 None 

2 9 

3 16 

4 17 

5 18 

6 20 
Item 20, page 4 

4/2004; Updated 3/18/2005 

7 21 

8 23 

9 None 

SAMPLE ERROR MESSAGE AND QUERY SCREENS 

The data entered in the electronic certificate indicates an unlikely level of 

education for the mother at her age. 

Mother’s education level is: ______________________________________ 

 

Please check one of the boxes below. 

 Incorrect 

 Correct 

 Not able to verify 

If the correct box is checked, the following message and query appears: 

Mother’s date of birth as entered is _______________ 

Please check one of the boxes below. 

 Incorrect 

 Correct 

 Not able to verify 

If the “Correct” button for both education and age is checked, the bypass flag is set to 

ON-1. 

If the “Not able to verify” button is checked, the bypass flag is set to ON-2. 

If the “Incorrect” button is selected for education, the education selection screen 

appears. 

 The message asks that an education level be selected. If the edit fails, the bypass flag is 

set to ON-1. If the edit passes, reset bypass flag to OFF-0. 

If the “Incorrect” button is selected for mother’s date of birth, the mother’s date of birth 

screen appears. Please enter the correct date of birth 

Month of mother’s birth ___ ___ 
Item 20, page 5 

4/2004; Updated 3/18/2005 

Day of mother’s birth ___ ___ 

Year of mother’s birth ___ ___ ___ ___ 

If the edit fails, the bypass flag is set to ON-1. If the edits passes, reset the bypass flag to 

OFF-0 

PAPER RECORD 

The same edits are run on data entered through the State system. The initial edit will 

catch only keying errors. If the edit fails, a message appears indicating a discrepancy 

between age and education. The keyer is asked to re-enter the data. If the edit passes, the 

bypass flag is set to OFF-0. If the data still fail the edit, the bypass flag is set to ON-2. 

NCHS TRANSMISSION FILE 

VARIABLES: 

 NAME LENGTH TYPE VALUE

MEDUC 1 Numeric 1, 2, 3, 4, 5, 6, 7, 8, 9 

MEDUC_BYPASS 1 Numeric 0, 1, 2 

EDI TRANSMISSION: 

No standards set yet. 
Item 21, page 1 

4/2004; Updated 3/18/2005 

Item Title: MOTHER OF HISPANIC ORIGIN?

Item Number: 21 Certificate, 9 Mother’s worksheet

Description: The Hispanic origin of the mother.

Source of Information:

Preferred Source: Mother or other informant 

 

INSTRUCTIONS 

FOR A PAPER RECORD: 

Based on the mother’s response to the worksheet or the interview, select all the 

corresponding checkboxes on the certificate and fill in any literal (written) responses. If 

mother has chosen more than one response, check all that she selected; for example, if 

both Mexican and Cuban are checked, select both responses. If the mother indicates an 

ethnic origin not on the list, record it in the “Specify” space. Enter the mother’s response 

in this space even if it is not a Hispanic origin. If the mother did not respond, type or 

print “Unknown.” 

MOTHER OF HISPANIC ORIGIN? (Check the box that best describes whether the 

mother is Spanish/Hispanic/Latina. Check the “No” box if mother is not 

Spanish/Hispanic/Latina) 

 

 No, not Spanish/Hispanic/Latina 

 Yes, Mexican, Mexican American, Chicana 

 Yes, Puerto Rican 

 Yes, Cuban 

 Yes, Other Spanish/Hispanic/Latina 

 (Specify)_____________________ 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

Hispanic origin will be selected from a menu list (below). The instructions should appear 

with the menu list. 

Based on the mother’s response, select all the corresponding boxes from the 

menu below and fill in any literal responses exactly as written on the 

worksheet regardless of whether or not any checkboxes are marked. If the 

mother has chosen more than one response, check all that she has selected; 
Item 21, page 2 

4/2004; Updated 3/18/2005 

for example, if both Mexican and Cuban are checked, select both responses. 

If the mother indicates an ethnic origin not on the list, record it in the 

“Specify” space. Enter the mother’s response in this space even if it is not a 

Hispanic origin. If the mother did not respond, check “Unknown if 

Spanish/Hispanic/Latina.” 

 MOTHER OF HISPANIC ORIGIN? 

 

  No, not Spanish/Hispanic/Latina 

 Yes, Mexican, Mexican American, Chicana 

 Yes, Puerto Rican 

 Yes, Cuban 

 Yes, Other Spanish/Hispanic/Latina (e.g. Spaniard, 

Salvadoran, Columbian) 

(Specify)________________________ 

 Unknown if Spanish/Hispanic/Latina 

If the “Yes, Other Spanish/Hispanic/Latina” button is selected, the following message 

will appear: 

Please enter the specified “other Hispanic origin.” 

Other:________________________ 

States may give examples of the largest “other Hispanic origin” groups for that State. 

Because more than one ethnicity may be reported, there should be a separate field for 

each of the 4 categories plus a 20-character field in which to enter the “other (specify)” 

response. 

When the “No, not Spanish/Hispanic/Latina” response is chosen, each of the Hispanic 

origin fields will be automatically coded with the “No, not Hispanic” code. When the 

keyer moves to another item and at least one Hispanic category is selected, all the 

Hispanic selections that were not chosen will be automatically coded with the “No, not 

Hispanic” code. 

 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

METHNIC1 Mexican, Mexican Ameri- N No, not Mexican 

 can or Chicana H Yes, Mexican 

 U Unknown 

METHNIC2 Puerto Rican N No, not Puerto Rican 
Item 21, page 3 

4/2004; Updated 3/18/2005 

H Yes, Puerto Rican 

 U Unknown 

METHNIC3 Cuban N No, not Cuban 

H Yes, Cuban 

 U Unknown 

METHNIC4 Other N No, not Other Hisp 

H Yes, Other Hisp 

 U Unknown 

METHNIC5 Other literal entry literal 

(blank) 

 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

Electronic record must contain one or more valid responses indicated above. If not, a 

query message appears before the record can be printed or filed. A replica of the entry 

screen appears and indicates that one of the categories below must be selected. If states 

elect to use a missing value variable (*_MVR) for this item, it must have a valid missing 

value code when the ethnicity values are coded to “unknown.” 

If the "Unknown if Spanish/Hispanic/Latina origin" box is checked, assign the value "S" 

to the ***_MVR variable and "U" to all other variables 

Any of the Hispanic variables may have an H code. If the mother is not Hispanic, all 

codes must be N’s. If the response is “Unknown,” all coded fields must contain a U and 

the literal field blank. 

PAPER RECORD 

Records filed with no entry are queried. If no response to query, code to “Unknown.” 

State edits of data file prior to NCHS transmission 

Records with more than one category of Hispanic checked will be transmitted with all 

codes to NCHS. 

All “other (specify)” literals will be reviewed to see if they are of Hispanic origin (see 

Appendix D). If the literal is in the Appendix and of Hispanic origin, the value of the 

variable, METHNIC4, will be set to “H,” Hispanic origin. If not, it will be set to “N,” not 

Hispanic origin. 
Item 21, page 4 

4/2004; Updated 3/18/2005 

Must be valid codes (see above). 

 

STATE FILE CONSIDERATIONS 

States opting to electronically code any of the “other (specify)” responses to the Hispanic 

origin question might want to consider using the HISSB standard coding structure for 

ethnicity. A field would have to be added to record these codes, and the codes then 

collapsed into the DVS/NCHS structure for transmission. 

Because of the possibility of “Unknown,” responses, a missing value variable is 

recommended to keep track of these responses for intervention, or for follow-up training. 

All these codes will result in an “Unknown” code for each of the ethnicity fields. The 

recommended variable name is METHNIC_MVR. 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

 NAME LENGTH TYPE VALUE

METHNIC1 1 Alpha character string N, H, U 

METHNIC2 1 Alpha character string N, H, U 

METHNIC3 1 Alpha character string N, H, U 

METHNIC4 1 Alpha character string N, H, U 

METHNIC5 20 Alpha character string literal, blank

 

EDI TRANSMISSION: 

No standards set yet. 

As a coding service, NCHS can provide the coded Hispanic Origin literals. See 

Appendix D for current codes.
Item 22, page 1 

4/2004; Updated 3/18/2005 

Item Title: MOTHER’S RACE 

Item Number: 22 certificate, 10 mother’s worksheet

Description: The race(s) that best describes what the mother considers 

herself to be. 

Source of Information:

Preferred Source: The mother 

INSTRUCTIONS 

PAPER RECORD 

Based on the mother’s response to the worksheet or interview, select all the 

corresponding checkboxes on the certificate and fill in any literal (written) 

responses exactly as given regardless of whether or not any checkboxes are 

marked. If more than one response has been chosen, check all selected; for 

example, if both “Black” and “Chinese” are checked, select both responses. If 

there is no response, type or print “Unknown.” 

MOTHER’S RACE (Check one or more races to indicate what the mother 

considers herself to be) 

 White 

 Black or African American 

 American Indian or Alaska Native 

 (Name of the enrolled or principal tribe)________________ 

 Asian Indian 

 Chinese 

 Filipino 

 Japanese 

 Korean 

 Vietnamese 

 Other Asian (Specify)______________________________ 

 Native Hawaiian 

 Guamanian or Chamorro 

 Samoan 

 Other Pacific Islander (Specify)______________________ 

 Other (Specify)___________________________________ 
Item 22, page 2 

4/2004; Updated 3/18/2005 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

The item is completed by selecting one or more races from the menu and/or completing 

any literal responses. The instructions should appear when the item is to be completed. 

Based on the mother’s response, select all the corresponding boxes from the 

menu below and fill in any literal responses exactly as written on the 

worksheet regardless of whether or not any checkboxes are marked. If more 

than one race has been chosen, check all selected; for example, if both 

“Black” and “Chinese” are marked, select both responses. If there is no 

response, check “Unknown.” 

Menu 

MOTHER’S RACE 

 White 

 Black or African American 

 American Indian or Alaska Native 

Tribe(s)_________________________________________ 

 _________________________________________ 

 Asian Indian 

 Chinese 

 Filipino 

 Japanese 

 Korean 

 Vietnamese 

 Other Asian 

Specify_________________________________________ 

 _________________________________________ 

 Native Hawaiian 

 Guamanian or Chamorro 

 Samoan 

 Other Pacific Islander 

 Specify_________________________________________ 

 _________________________________________ 

 Other 

 Specify_________________________________________

 _________________________________________ 

 Unknown 

 

 

PROCESSING VARIABLES: 
Item 22, page 3 

4/2004; Updated 3/18/2005 

NAME DESCRIPTION VALUES DEFINITION

MRACE1 White checkbox Y Box for race checked 

N Box for race not checked 

MRACE2 Black or African American Y Box for race checked 

 checkbox N Box for race not checked 

 

MRACE3 American Indian or Y Box for race checked 

Alaska Native checkbox N Box for race not checked 

 

MRACE4 Asian Indian checkbox Y Box for race checked 

N Box for race not checked 

MRACE5 Chinese checkbox Y Box for race checked 

N Box for race not checked 

MRACE6 Filipino checkbox Y Box for race checked 

N Box for race not checked 

MRACE7 Japanese checkbox Y Box for race checked 

N Box for race not checked 

 

FRACE8 Korean checkbox Y Box for race checked 

N Box for race not checked 

 

MRACE9 Vietnamese checkbox Y Box for race checked 

N Box for race not checked 

 

MRACE10 Other Asian checkbox Y Box for race checked 

 N Box for race not checked 

 

MRACE 11 Native Hawaiian checkbox Y Box for race checked 

N Box for race not checked 

 

MRACE 12 Guamanian or Chamorro Y Box for race checked 

 checkbox N Box for race not checked 

 

MRACE 13 Samoan checkbox Y Box for race checked 

N Box for race not checked 

 

MRACE14 Other Pacific Islander Y Box for race checked 

 checkbox N Box for race not checked 

 
Item 22, page 4 

4/2004; Updated 3/18/2005 

MRACE15 Other checkbox Y Box for race checked 

N Box for race not checked 

 

MRACE16 First American Indian or Literal responses, blank 

Alaska Native literal 

MRACE17 Second American Indian or Literal responses, blank 

Alaska Native literal 

MRACE18 First Other Asian literal Literal responses, blank 

MRACE19 Second Other Asian literal Literal responses, blank 

MRACE20 First Other Pacific 

Islander literal Literal responses, blank 

MRACE21 Second Other Pacific 

Islander literal Literal responses, blank 

MRACE22 First Other literal Literal responses, blank 

MRACE23 Second Other literal Literal responses, blank 

EDITS: 

Before the record is transmitted to the State 

ELECTRONIC RECORD

An entry must be made before another entry field can appear. If the keyer tries to move to 

another item, a message should appear asking that the Race of the Mother be completed. 

If the” unknown” box is checked, no other boxes checked and there are no literal entries, 

each race checkbox variable is assigned the “N” code, and all literals are filled with Ns. 

Record cannot be filed or printed unless at least one box is checked. 

 

If the “Unknown,” box is checked, and one or more specific race items are checked, 

ignore the “Unknown.” 

When a specific race box is selected (checked), the value Y is assigned to that variable. 

PAPER RECORD

Records filed with this field blank are queried. If no response to query, assign the “N” 

code. 

If the response is “Unknown,” all fields must contain N. 
Item 22, page 5 

4/2004; Updated 3/18/2005 

STATE FILE CONSIDERATIONS 

After the record is transmitted to NCHS, the responses on the race item are processed 

through the coding and editing algorithms developed and operated by NCHS. The coding 

algorithm assigns a three-digit code to each race processing-variable with an initial 

positive response, either directly for check-box races or through a table lookup using a 

table developed and maintained by NCHS. * If the race is not found in the table, the code 

for “other” is assigned. NCHS has also developed an imputation procedure for use when 

race is unknown. 

Initial responses on the standard certificate race format are handled with 15 single-digit 

fields for check-boxes (MRACE1-MRACE15) and up to eight 30 character fields for 

literal entries, two for each of the four write-in lines (MRACE16-MRACE23). Threedigit codes assigned by the coding algorithm to the literal positive responses are stored in 

MRACE16C-MRACE23C. 

The set of three-digit codes assigned to the initial race responses are run through an edit 

and reduction algorithm consistent with the basic year 2000 census edits, also developed 

and operated by NCHS. This algorithm eliminates redundant responses and adjusts 

inconsistent responses to determine the best set of codes for the responses. If a Hispanic 

response is entered in the “Other” field, an allocation of race is made at the same time 

that the edit and reduction algorithm is run. 

Output from the edit and reduction algorithm includes up to eight possible race codes 

stored in variables MRACE1E thru MRACE8E. These eight race output variables are the 

ones to be used for tabulation purposes. To save States from the effort of duplicating this 

complicated process, NCHS will transmit the edited race codes to the States. In addition, 

NCHS will transmit back to the States all the processing variables as initially recorded, 

including all the literal entries as well as the pre-edit codes NCHS assigns to these literal 

entries. 

States may, of course, elect to code these data internally. However, only uncoded data 

will be transmitted to NCHS to assure that these data are processed in a comparable 

fashion. 

* At some point in the future, the transmission of data from the States to NCHS and 

back again will be done using "HL7-version 3" standard messaging with XML 

technology. Once XML messaging is established, States will convert data from their 

databases into XML messages with NEDSS codes and/or literals for transmission to 

NCHS. It is important to note, however, that until HL7/XML messaging is established, 

NCHS will continue to use the 3-digit format outlined above for transmission. 

NCHS TRANSMISSION FILE 
Item 22, page 6 

4/2004; Updated 3/18/2005 

VARIABLES: 

NAMES LENGTH TYPE VALUES

MRACE1 1 Alpha character string Y, N 

MRACE2 1 Alpha character string Y, N 

MRACE3 1 Alpha character string Y, N 

MRACE4 1 Alpha character string Y, N 

MRACE5 1 Alpha character string Y, N 

MRACE6 1 Alpha character string Y, N 

MRACE7 1 Alpha character string Y, N 

MRACE8 1 Alpha character string Y, N 

MRACE9 1 Alpha character string Y, N 

MRACE10 1 Alpha character string Y, N 

MRACE11 1 Alpha character string Y, N 

MRACE12 1 Alpha character string Y, N 

MRACE13 1 Alpha character string Y, N 

MRACE14 1 Alpha character string Y, N 

MRACE15 1 Alpha character string Y, N 

MRACE16 30 Alpha character string Literal, blank 

MRACE17 30 Alpha character string Literal, blank 

MRACE18 30 Alpha character string Literal, blank 

MRACE19 30 Alpha character string Literal, blank 

MRACE20 30 Alpha character string Literal, blank 

MRACE21 30 Alpha character string Literal, blank 

MRACE22 30 Alpha character string Literal, blank 

MRACE23 30 Alpha character string Literal, blank 

TO BE PRODUCED BY THE NCHS EDITING ALGORITHM 

MRACE1E 3 Alpha-numeric character string Appendix E 

MRACE2E 3 Alpha-numeric character string Appendix E 

MRACE3E 3 Alpha-numeric character string Appendix E 

MRACE4E 3 Alpha-numeric character string Appendix E 

MRACE5E 3 Alpha-numeric character string Appendix E 

MRACE6E 3 Alpha-numeric character string Appendix E 

MRACE7E 3 Alpha-numeric character string Appendix E 

MRACE8E 3 Alpha-numeric character string Appendix E 

TO BE PRODUCED BY THE NCHS CODING ALGORITHM 

MRACE16C 3 Alpha-numeric character string Appendix E 

MRACE17C 3 Alpha-numeric character string Appendix E 

MRACE18C 3 Alpha-numeric character string Appendix E 

MRACE19C 3 Alpha-numeric character string Appendix E 

MRACE20C 3 Alpha-numeric character string Appendix E 
Item 22, page 7 

4/2004; Updated 3/18/2005 

MRACE21C 3 Alpha-numeric character string Appendix E 

MRACE22C 3 Alpha-numeric character string Appendix E 

MRACE23C 3 Alpha-numeric character string Appendix E 

EDI TRANSMISSION: No standards set yet. 
Item 23, page 1 

4/2004; Updated 3/18/2005 

Item Title: FATHER’S EDUCATION

Item Number: 23 Certificate, 21 Mother’s worksheet

Description: The highest degree or level of schooling completed by 

the father at the time of this delivery

Source of Information:

Preferred Source: Mother or father

INSTRUCTIONS 

FOR A PAPER RECORD: 

Based on the mother’s or father’s response to the worksheet or interview, check the 

appropriate box in the listing on the certificate. If the item is blank and either parent is 

still in the facility, query. If the parents have left the facility write in “Unknown” in the 

space. 

FATHER’S EDUCATION 

(Check the box that best describes the highest degree or level of school completed at the 

time of delivery) 

 8th grade or lesse 

 9th-12th grade; no diploma 

 High school graduate or GED completed 

 Some college credit, but not a degree 

 Associate degree (e.g. AA, AS) 

 Bachelor’s degree (e.g. BA, AB, BS) 

 Master’s degree (e.g. MA, MS, MEng, MEd, MSW,MBA) 

 Doctorate (e.g. PhD, EdD) or Professional degree (e.g. MD, DDS, DVM, LLB, 

JD) 
Item 23, page 2 

4/2004; Updated 3/18/2005 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

Father’s education level is chosen from the list below and the instructions should appear 

when the item is to be completed. 

Father’s Education 

Based on the response to the worksheet or interview, check the category that 

best describes the highest degree or level of school completed. 

 8th grade or less 

 9th-12th grade; no diploma 

 High school graduate or GED completed 

 Some college credit, but not a degree 

 Associate degree (e.g. AA, AS) 

 Bachelor’s degree (e.g. BA, AB, BS) 

 Master’s degree (e.g. MA, MS, MEng, MEd, MSW, 

MBA) 

 Doctorate (e.g. PhD, EdD) or Professional degree 

(e.g. MD, DDS, DVM, LLB, JD) 

 Unknown 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

FEDUC 1 8th grade or less 

2 9th through 12th grade; no 

diploma 

3 High school graduate or GED 

completed 

4 Some college credit, but not a 

degree 

5 Associate degree (e.g., AA, 

AS) 

6 Bachelor’s degree (e.g., BA, 

AB, BS) 

7 Master’s degree (e.g., MA, 

MS, MEng, Med, MSW, 

MBA) 
Item 23, page 3 

4/2004; Updated 3/18/2005 

8 Doctorate degree (e.g., PhD, 

EdD) or professional degree 

(e.g., MD, DDS, DVM, LLB, 

JD) 

9 Unknown 

FEDUC_BYPASS 0 OFF (default value, edit 

passed) 

1 ON (edit failed, data queried 

and verified) 

2 ON (edit failed, data queried 

and not verified) 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

If the “Unknown” box is checked the following message should appear: 

If the parents are still in the facility, please obtain the father’s education level. If they 

have left the facility, please check the box below. 

 Parents have left the facility 

If the box is checked the item is not pended and will not appear on the final review 

screen. 

At the time of input to an EBR or electronic work sheet, Father’s date of birth will have 

been entered and edited. Father’s age at the time the worksheet is completed will be 

calculated and stored as a variable for the purposes of this edit 

If age/education edit indicates a discrepancy, the education information needs to be 

reviewed. 

Valid codes 1-9 (See processing variables for detail) 

 Values Minimum Age 

 

1 None 

2 9 

3 16 

4 17 

5 18 

6 20 

7 21 
Item 23, page 4 

4/2004; Updated 3/18/2005 

8 23 

9 None 

SAMPLE ERROR MESSAGE AND QUERY SCREENS 

The data entered in the electronic certificate indicates an unlikely level of 

education for the father for his age. 

Father’s education level is: ______________________________________ 

 Please check one of the boxes below. 

 Incorrect 

 Correct 

 Not able to verify

If the “Correct” button is checked, the bypass flag is set to ON-1. 

If the “Not able to verify” button is checked, the bypass flag is set to ON-2. 

If the “Incorrect” button is selected, the education selection list appears. The message 

asks that an education level be selected. If the edit fails, the bypass flag is set to ON-1. If 

the edit passes, reset bypass flag to OFF-0. 

PAPER RECORD 

The same edits are run on data entered through the State system. The initial edit will 

catch only keying errors. If the edit fails, a message appears indicating a discrepancy 

between age and education. The keyer is asked to re-enter the data. If the edit passes, the 

bypass flag is set to OFF-0. If the data still fail, the edit the bypass flag is set to ON-2. 

NCHS TRANSMISSION FILE 

VARIABLES: 

 NAME LENGTH TYPE VALUE

FEDUC 1 Numeric 1, 2, 3, 4, 5, 6, 7, 8, 9 

FEDUC_BYPASS 1 Numeric 0, 1, 2 

EDI TRANSMISSION: 

No standards set yet. 
Item 24, page 1 

4/2004; Updated 3/18/2005 

Item Title: FATHER OF HISPANIC ORIGIN?

Item Number: 24 Certificate, 22 Mother’s worksheet

Description: The Hispanic origin of the father.

Source of Information:

Preferred Source: Mother or father 

 

INSTRUCTIONS 

FOR A PAPER RECORD: 

Based on the mother’s or father’s response to the worksheet or the interview, select all 

the corresponding checkboxes on the certificate and fill in any literal (written) responses. 

If more than one response has been chosen, check all selected; for example, if both 

Mexican and Cuban are checked, select both responses. If an ethnic origin not on the list 

is indicated, record it in the “Specify” space. Enter the response in this space even if it is 

not a Hispanic origin. If no response, type or print “Unknown.” 

FATHER OF HISPANIC ORIGIN? (Check the box that best describes whether the 

father is Spanish/Hispanic/Latino. Check the “No” box if father is not 

Spanish/Hispanic/Latino) 

 

 No, not Spanish/Hispanic/Latino 

 Yes, Mexican, Mexican American, Chicano 

 Yes, Puerto Rican 

 Yes, Cuban 

 Yes, Other Spanish/Hispanic/Latino 

(Specify)________________________ 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

Hispanic origin will be selected from a menu list (below). The instructions should appear 

with the menu list. 

Based on the mother’s or father’s response, select all the corresponding 

boxes from the menu below and fill in any literal responses exactly as written 

on the worksheet regardless of whether or not any checkboxes are marked. 

If more than one response is chosen, check all selected; for example, if both 

Mexican and Cuban are checked, select both responses. If an ethnic origin 
Item 24, page 2 

4/2004; Updated 3/18/2005 

not on the list is indicated, record it in the “Specify” space. Enter the 

response in this space even if it is not a Hispanic origin. If no response, check 

“Unknown if Spanish/Hispanic/Latino.” 

 FATHER OF HISPANIC ORIGIN? 

 

  No, not Spanish/Hispanic/Latino 

 Yes, Mexican, Mexican American, Chicano 

 Yes, Puerto Rican 

 Yes, Cuban 

 Yes, Other Spanish/Hispanic/Latino (e.g. Spaniard, 

Salvadoran, Columbian) 

(Specify)________________________ 

 Unknown if Spanish/Hispanic/Latino 

If the “Yes, Other Spanish/Hispanic/Latino” button is selected, the following message 

will appear: 

Please enter the specified “other Hispanic origin.” 

Other:________________________ 

States may give examples of the largest “other Hispanic origin” groups for that State. 

Because more than one ethnicity may be reported, there should be a separate field for 

each of the 4 categories plus a 20-character field in which to enter the “other (specify)” 

response. 

When the “No, not Spanish/Hispanic/Latino” response is chosen, each of the Hispanic 

origin fields will be automatically coded with the “No, not Hispanic” code. When the 

keyer moves to another item and at least one Hispanic category is selected, all the 

Hispanic selections that were not chosen will be automatically coded with the “No, not 

Hispanic” code. 

 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

FETHNIC1 Mexican, Mexican Ameri- N No, not Mexican 

 can or Chicano H Yes, Mexican 

 U Unknown 

FETHNIC2 Puerto Rican N No, not Puerto Rican 

H Yes, Puerto Rican 

 U Unknown 
Item 24, page 3 

4/2004; Updated 3/18/2005 

FETHNIC3 Cuban N No, not Cuban 

H Yes, Cuban 

 U Unknown 

FETHNIC4 Other N No, not Other Hisp 

H Yes, Other Hisp 

 U Unknown 

FETHNIC5 Other literal entry literal 

(blank) 

 

EDITS: 

ELECTRONIC RECORD

Before the record is transmitted to the State 

Electronic record must contain one or more valid responses indicated above. If not, a 

query message appears before the record can be printed or filed. A replica of the entry 

screen appears and indicates that one of the categories below must be selected. If states 

elect to use a missing value variable (*_MVR) for this item, it must have a valid missing 

value code when the ethnicity values are coded to “unknown.” 

If the "Unknown if Spanish/Hispanic/Latino origin" box is checked, assign the value "S" 

to the ***_MVR variable and "U" to all other variables 

Any of the Hispanic variables may have an H code. If the father is not Hispanic, all 

codes must be N’s. If the response is “Unknown,” all coded fields must contain a U and 

the literal field blank. 

PAPER RECORD 

Records filed with no entry are queried. If no response to query, code to “Unknown.” 

State edits of data file prior to NCHS transmission 

Records with more than one category of Hispanic checked will be transmitted with all 

codes to NCHS. 

All “other (specify)” literals should be reviewed to see if they are of Hispanic origin (See 

Appendix D). If the literal is in the Appendix and of Hispanic origin, the value of the 

variable, FETHNIC4, will be set to “H,” Hispanic origin. If not, it will be set to “N,” not 

Hispanic origin. 

Must be valid codes (see above). 
Item 24, page 4 

4/2004; Updated 3/18/2005 

 

STATE FILE CONSIDERATIONS 

States opting to electronically code any of the “other (specify)” responses to the Hispanic 

origin question might want to consider using the HISSB standard coding structure for 

ethnicity. A field would have to be added to record these codes, and the codes then 

collapsed into the DVS/NCHS structure for transmission. 

Because of the possibility “Unknown,” responses, a missing value variable is 

recommended to keep track of these responses for intervention, or for follow-up training. 

All these codes will result in an “Unknown” code for each of the ethnicity fields. The 

recommended variable name is FETHNIC_MVR. 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

 NAME LENGTH TYPE VALUE

FETHNIC1 1 Alpha character string N, H, U 

FETHNIC2 1 Alpha character string N, H, U 

FETHNIC3 1 Alpha character string N, H, U 

FETHNIC4 1 Alpha character string N, H, U 

FETHNIC5 20 Alpha character string literal, blank

 

EDI TRANSMISSION: 

No standards set yet. 

As a coding service, NCHS can provide the coded Hispanic Origin literals. See 

Appendix D for current codes.
Item 25, page 1 

4/2004; Updated 3/18/2005 

Item Title: FATHER’S RACE 

Item Number: 25 certificate, 23 mother’s worksheet

Description: The race(s) that best describes what the father considers 

himself to be. 

Source of Information:

Preferred Source: The father 

INSTRUCTIONS 

PAPER RECORD 

Based on the response to the worksheet or interview, select all the corresponding 

checkboxes on the certificate and fill in any literal (written) responses exactly as 

given regardless of whether or not any checkboxes are marked. If more than one 

response has been chosen, check all selected; for example, if both “Black” and 

“Chinese” are checked, select both responses. If there is no response, type or 

print “Unknown.” 

FATHER’S RACE (Check one or more races to indicate what the father 

considers himself to be) 

 White 

 Black or African American 

 American Indian or Alaska Native 

 (Name of the enrolled or principal tribe)________________ 

 Asian Indian 

 Chinese 

 Filipino 

 Japanese 

 Korean 

 Vietnamese 

 Other Asian (Specify)______________________________ 

 Native Hawaiian 

 Guamanian or Chamorro 

 Samoan 

 Other Pacific Islander (Specify)______________________ 

 Other (Specify)___________________________________ 
Item 25, page 2 

4/2004; Updated 3/18/2005 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

The item is completed by selecting one or more races from the menu and/or completing 

any literal responses. The instructions should appear when the item is to be completed. 

Based on the response to the worksheet, select all the corresponding boxes 

from the menu below and fill in any literal responses exactly as written on 

the worksheet regardless of whether or not any checkboxes are marked. If 

more than one race has been chosen, check all selected; for example, if both 

“Black” and “Chinese” are marked, select both responses. If there is no 

response, check “Unknown.” 

FATHER’S RACE 

 White 

 Black or African American 

 American Indian or Alaska Native 

Tribe(s)_________________________________________ 

 _________________________________________ 

 Asian Indian 

 Chinese 

 Filipino 

 Japanese 

 Korean 

 Vietnamese 

 Other Asian 

Specify_________________________________________ 

 _________________________________________ 

 Native Hawaiian 

 Guamanian or Chamorro 

 Samoan 

 Other Pacific Islander 

 Specify_________________________________________ 

 _________________________________________ 

 Other 

 Specify_________________________________________

 _________________________________________ 

 Unknown 

 

 
Item 25, page 3 

4/2004; Updated 3/18/2005 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

FRACE1 White checkbox Y Box for race checked 

N Box for race not checked 

FRACE2 Black or African American Y Box for race checked 

 checkbox N Box for race not checked 

 

FRACE3 American Indian or Y Box for race checked 

Alaska Native checkbox N Box for race not checked 

 

FRACE4 Asian Indian checkbox Y Box for race checked 

N Box for race not checked 

FRACE5 Chinese checkbox Y Box for race checked 

N Box for race not checked 

FRACE6 Filipino checkbox Y Box for race checked 

N Box for race not checked 

FRACE7 Japanese checkbox Y Box for race checked 

N Box for race not checked 

 

FRACE8 Korean checkbox Y Box for race checked 

N Box for race not checked 

 

FRACE9 Vietnamese checkbox Y Box for race checked 

N Box for race not checked 

 

FRACE10 Other Asian checkbox Y Box for race checked 

 N Box for race not checked 

 

FRACE 11 Native Hawaiian checkbox Y Box for race checked 

N Box for race not checked 

 

FRACE 12 Guamanian or Chamorro Y Box for race checked 

 checkbox N Box for race not checked 

 

FRACE 13 Samoan checkbox Y Box for race checked 

N Box for race not checked 

 

FRACE14 Other Pacific Islander Y Box for race checked 

 checkbox N Box for race not checked 

 
Item 25, page 4 

4/2004; Updated 3/18/2005 

FRACE15 Other checkbox Y Box for race checked 

N Box for race not checked 

 

FRACE16 First American Indian or Literal responses, blank 

Alaska Native literal 

FRACE17 Second American Indian or Literal responses, blank 

Alaska Native literal 

FRACE18 First Other Asian literal Literal responses, blank 

FRACE19 Second Other Asian literal Literal responses, blank 

FRACE20 First Other Pacific 

Islander literal Literal responses, blank 

FRACE21 Second Other Pacific 

Islander literal Literal responses, blank 

FRACE22 First Other literal Literal responses, blank 

FRACE23 Second Other literal Literal responses, blank 

 

EDITS: 

Before the record is transmitted to the State 

ELECTRONIC RECORD

An entry must be made before another entry field can appear. If the keyer tries to move to 

another item, a message should appear asking that the Race of the Father be completed. 

If the” unknown” box is checked, no other boxes checked and there are no literal entries, 

each race checkbox variable is assigned the “N” code, and all literals are filled with Ns. 

Record cannot be filed or printed unless at least one box is checked. 

 

If the “Unknown,” box is checked, and one or more specific race items are checked, 

ignore the “Unknown.” 

When a specific race box is selected (checked), the value Y is assigned to that variable. 

PAPER RECORD

Records filed with this field blank are queried. If no response to query, assign the “N” 

code. 

If the response is “Unknown,” all fields must contain N. 
Item 25, page 5 

4/2004; Updated 3/18/2005 

STATE FILE CONSIDERATIONS 

After the record is transmitted to NCHS, the responses on the race item are processed 

through the coding and editing algorithms developed and operated by NCHS. The coding 

algorithm assigns a three-digit code to each race processing-variable with an initial 

positive response, either directly for check-box races or through a table lookup using a 

table developed and maintained by NCHS. * If the race is not found in the table, the code 

for “other” is assigned. NCHS has also developed an imputation procedure for use when 

race is unknown. 

Initial responses on the standard certificate race format are handled with 15 single-digit 

fields for check-boxes (MRACE1-MRACE15) and up to eight 30 character fields for 

literal entries, two for each of the four write-in lines (MRACE16-MRACE23). Threedigit codes assigned by the coding algorithm to the literal positive responses are stored in 

MRACE16C-MRACE23C. 

The set of three-digit codes assigned to the initial race responses are run through an edit 

and reduction algorithm consistent with the basic year 2000 census edits, also developed 

and operated by NCHS. This algorithm eliminates redundant responses and adjusts 

inconsistent responses to determine the best set of codes for the responses. If a Hispanic 

response is entered in the “Other” field, an allocation of race is made at the same time 

that the edit and reduction algorithm is run. 

Output from the edit and reduction algorithm includes up to eight possible race codes 

stored in variables MRACE1E thru MRACE8E. These eight race output variables are the 

ones to be used for tabulation purposes. To save States from the effort of duplicating this 

complicated process, NCHS will transmit the edited race codes to the States. In addition, 

NCHS will transmit back to the States all the processing variables as initially recorded, 

including all the literal entries as well as the pre-edit codes NCHS assigns to these literal 

entries. 

States may, of course, elect to code these data internally. However, only uncoded data 

will be transmitted to NCHS to assure that these date are processed in a comparable 

fashion. 

* At some point in the future, the transmission of data from the States to NCHS and 

back again will be done using "HL7-version 3" standard messaging with XML 

technology. Once XML messaging is established, States will convert data from their 

databases into XML messages with NEDSS codes and/or literals for transmission to 

NCHS. It is important to note, however, that until HL7/XML messaging is established, 

NCHS will continue to use the 3-digit format outlined above for transmission. 
Item 25, page 6 

4/2004; Updated 3/18/2005 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAMES LENGTH TYPE VALUES

FRACE1 1 Alpha character string Y, N 

FRACE2 1 Alpha character string Y, N 

FRACE3 1 Alpha character string Y, N 

FRACE4 1 Alpha character string Y, N 

FRACE5 1 Alpha character string Y, N 

FRACE6 1 Alpha character string Y, N 

FRACE7 1 Alpha character string Y, N 

FRACE8 1 Alpha character string Y, N 

FRACE9 1 Alpha character string Y, N 

FRACE10 1 Alpha character string Y, N 

FRACE11 1 Alpha character string Y, N 

FRACE12 1 Alpha character string Y, N 

FRACE13 1 Alpha character string Y, N 

FRACE14 1 Alpha character string Y, N 

FRACE15 1 Alpha character string Y, N 

FRACE16 30 Alpha character string Literal, blank 

FRACE17 30 Alpha character string Literal, blank 

FRACE18 30 Alpha character string Literal, blank 

FRACE19 30 Alpha character string Literal, blank 

FRACE20 30 Alpha character string Literal, blank 

FRACE21 30 Alpha character string Literal, blank 

FRACE22 30 Alpha character string Literal, blank 

FRACE23 30 Alpha character string Literal, blank 

TO BE PRODUCED BY THE NCHS EDITING ALGORITHM 

FRACE1E 3 Alpha-numeric character string Appendix E 

FRACE2E 3 Alpha-numeric character string Appendix E 

FRACE3E 3 Alpha-numeric character string Appendix E 

FRACE4E 3 Alpha-numeric character string Appendix E 

FRACE5E 3 Alpha-numeric character string Appendix E 

FRACE6E 3 Alpha-numeric character string Appendix E 

FRACE7E 3 Alpha-numeric character string Appendix E 

FRACE8E 3 Alpha-numeric character string Appendix E 

TO BE PRODUCED BY THE NCHS CODING ALGORITHM 

FRACE16C 3 Alpha-numeric character string Appendix E 

FRACE17C 3 Alpha-numeric character string Appendix E 

FRACE18C 3 Alpha-numeric character string Appendix E 
Item 25, page 7 

4/2004; Updated 3/18/2005 

FRACE19C 3 Alpha-numeric character string Appendix E 

FRACE20C 3 Alpha-numeric character string Appendix E 

FRACE21C 3 Alpha-numeric character string Appendix E 

FRACE22C 3 Alpha-numeric character string Appendix E 

FRACE23C 3 Alpha-numeric character string Appendix E 

EDI TRANSMISSION: No standards set yet. 
Item 27, page 1 

4/2004; Updated 3/18/2005 

Item Title: ATTENDANT’S NAME, TITLE, AND NPI 

Item Number: 27 Certificate, 25 Facility worksheet

 

Description: The name of the attendant (the person responsible for delivering 

the child), their title, and their National Provider Identification 

(NPI) Number. 

The attendant at birth is defined as the individual at the delivery 

who is responsible for the delivery. For example, if an intern or 

nurse-midwife delivers an infant under the supervision of an 

obstetrician who is present in the delivery room, the obstetrician is 

to be reported as the attendant. However, a person who is not 

physically present at the delivery should not be reported as the 

attendant. For example, if the obstetrician is not physically 

present, the intern or nurse-midwife MUST be reported as the 

attendant. 

Source of Information: 

Preferred Source: Delivery record 

Other Source: Attendant

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

This item is to be completed by the facility. If the birth did not occur in a facility, it is to 

be completed by the attendant or certifier. 

Please print or type the name of the person who attended the birth and their National 

Provider Identification (NPI) number: 

NAME:_______________________________NPI__________________ 

If attendant does not have an NPI number, type or print “none.” If the attendant 

should have an NPI number but it is unknown, type or print “unknown.” 
Item 27, page 2 

4/2004; Updated 3/18/2005 

Please check one box below to specify the attendant’s title. If the “other 

(specify)” box is checked, please print or type the title of the attendant. Examples 

include: nurse, father, police officer, EMS technician, etc. 

 MD 

 DO 

 CNM/CM 

 Other midwife 

 Other (specify)_______________ 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in italics) 

The following definition should be available in the help function: 

The attendant at birth The attendant at birth is defined as the individual at the delivery 

who is responsible for the delivery. For example, if an intern or nurse-midwife delivers 

an infant under the supervision of an obstetrician who is present in the delivery room, the 

obstetrician is to be reported as the attendant. However, a person who is not physically 

present at the delivery should not be reported as the attendant. For example, if the 

obstetrician is not physically present, the intern or nurse-midwife MUST be reported as 

the attendant. 

This item is to be completed by the facility. Data are to be keyed from the facility 

worksheet or from information obtained from the attendant. If the birth did not occur in a 

facility, it is to be completed by the attendant or certifier. 

Attendant’s Name, Title and NPI 

The attendant’s name should be three fields (last name, first name, middle name or 

initial). 

When the attendant’s name is entered the software should automatically examine 

a roster of attendants to see if the name is on the roster for the facility. If it is on 

the roster, the attendant’s title and NPI number are automatically completed. 

Note the software can be set up to bring up a name after only a few letters are 

entered. 

NOTE: This process can also be constructed as a drop down list of possible 
Item 27, page 3 

4/2004; Updated 3/18/2005 

attendants. But, this approach could easily lead to errors that cannot be caught or 

edited. 

If the name is not on the roster, the following screens will appear: 

Attendant’s National Provider Identification Number 

The instructions below should appear when the NPI is to be entered. 

If attendant does not have an NPI number, enter “none.” If the attendant 

should have an NPI number but it is unknown, enter “unknown.” 

Attendant’s Title 

 The attendant’s title is to be selected from the list below. 

 MD 

 DO 

 CNM/CM 

 Other midwife 

 Other(specify) 

 Unknown 

The system should be designed to allow only one box to be checked. 

If the “other” box is checked, following message appears: 

Please specify the title of the “other” attendant. Examples include: nurse, 

father, police officer, EMS technician, etc. 

After the above items are completed, an option of adding the attendant 

information to the facility roster of attendants is offered. 

Roster of Attendants 

Do you wish this information to be added to your facility’s roster of attendants? 

 Yes 

 No 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

ATTENDN Attendant’s name Alpha character string 
Item 27, page 4 

4/2004; Updated 3/18/2005 

NPI National provider Alpha/numeric 

 ID number 

ATTEND Type of attendant 1 MD 

 2 DO 

 3 CNM/CM 

 4 Other midwife 

 5 Other(specify) 

 9 Unknown 

ATTENDS Other specified attendant Alpha character string 

EDITS: 

ELECTRONIC RECORD 

Before the record is submitted to the State 

Record must have a name of an attendant. Only one attendant is allowed. If more than 

one box is checked the following message appears: 

More than one attendant was selected. Please choose one attendant from the 

menu below. 

Original menu appears: 

If “type of attendant” is blank, the record can not be filed or printed until item is 

complete. 

All “other (specify)” –“unknown” responses will be automatically coded to the “not 

classifiable” code. 

PAPER RECORD 

Records filed with the type of attendant blank or unknown should be queried. If no 

response to query, enter “unknown” in the other specify location. 

All “other (specify)” –“unknown” responses will be automatically be coded to the “not 

classifiable” code. 

If more than one attendant is selected, choose the first listed attendant. 

State Edits of data file prior to NCHS transmission 

Must be a valid code (see below). 

STATE FILE CONSIDERATIONS 
Item 27, page 5 

4/2004; Updated 3/18/2005 

State offices will have to design their software to handle the names of attendants and their 

NPI numbers. States may want to maintain only the NPI numbers and a reference list 

roster of names and other information about attendants. States may also want to code the 

“other (specify)” attendants. 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

 NAME LENGTH TYPE VALUES

ATTEND 1 Numeric 1,2,3,4,5,9 

EDI TRANSMISSION: 

No standards set yet. 
Item 28, page 1 

4/2004; Updated 3/18/2005 

Item Title: MOTHER TRANSFERRED FOR 

MATERNAL MEDICAL OR FETAL 

 INDICATIONS FOR DELIVERY? 

 

Item Number: 28 Certificate, 24 Facility work sheet

 

Description: Information of the transfer status of the mother prior to 

delivery 

Source of Information: 

Preferred Source: Labor and delivery nursing admission triage form, 

Admission history and physical, Labor and 

delivery 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

This item is to be completed by the facility. If the birth did not occur in a facility, it is to 

be completed by the attendant or certifier and the response must be “no.” 

MOTHER TRANSFERRED FOR MATERNAL MEDICAL OR FETAL 

INDICATIONS FOR DELIVERY? 

 Yes  No 

IF YES, ENTER NAME OF FACILITY MOTHER TRANSFERRED 

FROM: 

________________________________________________________ 

If the name of the facility is not known, enter “unknown.” 
Item 28, page 2 

4/2004; Updated 3/18/2005 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics) 

If the response to certificate item 26 is any response but hospital, this item is 

automatically completed with the “no” response and will not appear on the EBR screen. 

Was the mother transferred to this facility for maternal medical or fetal indications 

prior to delivery? Transfers include hospital to hospital, birthing facility to hospital 

etc. 

 Yes 

 No 

 Unknown

If the yes box is checked, the following appears: 

Please enter the name of the facility the mother transferred from. If the name of the 

facility is not known, enter “unknown.” 

Facility name:_____________________________ 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

TRAN Mother transferred Y Yes 

 N No 

 U Unknown 

NFACL Name of facility Alpha/Numeric 

EDITS: 

ELECTRONIC RECORD 

Before the record is transferred to the State 

The transfer status cannot be blank. 

If transfer status is left blank, the item will reappear at the final review screen. Record 

cannot be printed or transferred to the state until item is complete. 

If transfer status is “no”, the name of facility field must be blank. 

If the transfer status is “yes”, the name of facility field must have an entry. “Unknown” 
Item 28, page 3 

4/2004; Updated 3/18/2005 

is an acceptable entry. 

If the name of the facility field has any entry except “unknown” and the transfer status is 

“no”, a query message should appear indicating the inconsistency and asking that it be 

corrected. 

If transfer status is “yes”, the response to item 26 must be “hospital.” If any response 

but “hospital”, a query message should appear. Either certificate item 26 must be 

changed to “hospital” or certificate item 28 changed to “no.” 

PAPER RECORD 

Records filed with the transfer status blank shall be queried. If no response to query, enter 

response of “no.” 

If transfer status is “no”, the name of facility field must be blank. 

If the transfer status is “yes”, the name of facility field must have an entry. “Unknown” is 

an acceptable entry. 

If the name of the facility field has any entry except “unknown” and the transfer status is 

“no”, query the inconsistency and resolve. 

If transfer status is “yes”, then the response to certificate item 26 must be “hospital.” If 

not, query. Either certificate item 26 must be changed to “hospital” or certificate item 28 

changed to “no.” 

State Edits of data file prior to NCHS transmission 

Must be a valid code (see below) 

STATE FILE CONSIDERATIONS 

States will need to have a field for the literal entry of facility names. They may also want 

to collect the facility NPI number or assign their own facility code. 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

NAME: LENGTH TYPE VALUES 

TRAN 1 Alpha character string Y, N, U 
Item 28, page 4 

4/2004; Updated 3/18/2005 

EDI TRANSMISSION: 

 

No standards set yet. 
Item 29a29b, page 1 

4/2004; Updated 3/18/2005 

Item Title: DATES OF FIRST AND LAST PRENATAL 

CARE VISIT

Item Number: 29a Certificate, 6a Facility worksheet 

 29b Certificate, 6b Facility worksheet 

Description: Date that the mother had her first prenatal care visit. 

 Date that the mother had her last prenatal care visit. 

Source of Information: 

Preferred Source: Prenatal care record 

 Other Source: Initial physical exam 

INSTRUCTIONS 

If the information is not in the mother’s file, please contact the prenatal care provider and 

obtain a copy of the prenatal care record. 

DATA COLLECTION: 

The following paragraph appears on the paper worksheet provided by NCHS before the 

section of data to be obtained from the mother’s prenatal care record. The paragraph 

should also appear on an electronic worksheet just before the section of information to be 

obtained from the mother’s prenatal care record. 

“Information for this and the following items should come from the mother's 

prenatal care record and from other medical reports in the mother's chart, as well 

as the infant's medical record. If the mother's prenatal care record is not in her 

hospital chart, please contact her prenatal care provider to obtain the record, or a 

copy of the prenatal care information. Preferred and acceptable sources for each 

item are listed in worksheets. Please do not provide information from sources other 

than the medical records.” 

FOR A PAPER RECORD: 

Print or type the month, day, and year of the first prenatal care visit. 

Complete all parts of the date that are available; leave the rest blank. 

If it is not known whether the mother had prenatal care, or if she had care but the date of 

the first visit is not known, write in “unknown.” 

DATE OF FIRST PRENATAL CARE VISIT 

________/______/_________ 

 MM DD YYYY 
Item 29a29b, page 2 

4/2004; Updated 3/18/2005 

Print or type the month, day, and year of the last prenatal care visit recorded in the 

records. 

Complete all parts of the date that are available; leave the rest blank. 

If it is not known whether the mother had prenatal care, or if she had care but the date of 

the last visit is not known, write in “unknown.” 

DATE OF FIRST PRENATAL CARE VISIT 

________/______/_________ 

 MM DD YYYY 

If the mother had no prenatal care, check the “no prenatal care” box and leave the date 

blank. 

 No Prenatal Care 

FOR AN ELECTRONIC RECORD: 

 

EBR Developer (Instructions are in Italics)

When the date of first and last prenatal care visit is to be entered, it is critical that the 

recommended message screens appear when appropriate. 

The following message should appear first: 

Check this button if the information needed to complete the date of 

first and/or last prenatal care visit is currently not available, but an 

effort is being made to obtain it. 

 Information not currently available 

EBR developers may wish to use “?” or a hot key for unknowns and for responding to the 

above rather than a specific button. For example the instruction could read: 

Press the ______key if the information needed to complete this item is 

currently not available, but an effort is being made to obtain it. 

When this button is checked, the item is skipped and placed in pending status for 

completion at a later time. See “Final Review Screen.” 

Each part of the three-part date fields must be entered independently so that all parts of 

the dates which are known are captured. 

Complete ALL PARTS of the dates that are available. 
Item 29a29b, page 3 

4/2004; Updated 3/18/2005 

Leave blank any parts of the dates that are not known. 

Month of the first visit __ __ 

 Day of the first visit __ __ 

 Year of the first visit __ __ __ __ 

Did the mother receive any prenatal care? 

 Yes 

 No 

Month of the last visit __ __ 

 Day of the last visit __ __ 

 Year of the last visit __ __ __ __ 

If the “no prenatal care” button is checked, the date fields are automatically completed 

with the “no prenatal care” codes. However, the final review screen will include a query 

for the clerk, asking if this information is correct. The number of prenatal care visits is 

set to value “0” and the item is skipped. 

If the “no” box is checked on a paper record and entry is through the state data entry 

system, the date fields are automatically completed with the “no prenatal care” codes. 

Item 30 “Number of prenatal care visits” is set to value “0” and the item skipped. The 

“no prenatal care” code is assigned to the derived variable “Month prenatal care 

began.” 

 

If the “yes” button checked, the date fields are automatically completed with the 

“unknown” codes. Also, a message should appear that reads: 

Please obtain the mother’s prenatal care record or other hospital record in order to 

enter the date of the mother’s first prenatal care visit before the record is filed. 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

DOFP_MO Month of first prenatal care visit 01-12, 88, 99 

DOFP_DY Day of first prenatal care visit 01-31 (depending on month), 88,99 

DOFP_YR Year of first prenatal care visit Yr of child’s birth or yr of child’s 

 birth –1, 8888,9999 
Item 29a29b, page 4 

4/2004; Updated 3/18/2005 

DOLP_MO Month of last prenatal care visit 01-12, 88, 99 

DOLP_DY Day of last prenatal care visit 01-31 (depending on month), 

 88, 99 

DOLP_YR Year of last prenatal care visit Yr of child’s birth, or yr of child’s 

 birth –1, 8888, 9999 

88, 8888 No prenatal 

care 

 99, 9999 Unknown 

DNA29 Pending flag 0 OFF 

 1 ON 

PNC Prenatal care Y Yes 

 N No 

 

 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

New data entered at the time of an edit replaces any data currently in the data file. 

If the “Data not available at this time” box is checked, the pending flag is set to ON-1, 

the date variables are assigned the “unknown” codes and the edits are skipped. The item 

will appear on the final review screen. 

The date is checked for validity (a proper combination of month day and year). If any of 

the fields are not valid a message should appear and ask that the value be re-entered. 

Edits are re-run until valid values are entered. 

If there is a complete date for both the first and last prenatal care visits, the date of the 

first prenatal care visit must be earlier or the same as the date of the last prenatal care 

visit. If it is not, a message should appear pointing out the discrepancy and asking that 

the dates be re-entered. 

The dates of the first and last prenatal visits are compared to the date of delivery. The 

date of the first visit must be earlier than the date of delivery but no more than 10 months 
Item 29a29b, page 5 

4/2004; Updated 3/18/2005 

earlier. The date of the last visit can be no later than the date of delivery. The 

comparison is run only if a complete date is entered. If the date does not meet the edit 

criteria the following message appears: 

The date of ___ ___ ______ is not a valid date for this woman’s first 

prenatal care visit. Please check the date and re-enter: 

A date entry, even if it is the same date as currently entered, must be made on this 

screen. The entry operator cannot tab past this screen. The comparison is rerun 

with the newly entered date. If the edit still fails the date is accepted. 

PAPER RECORD 

The same edits as above are run when data are key entered through the state system. This 

should be done at the time of key entry for the state entry system. After a new date is 

entered, the edit must be rerun. If the edit still fails, a message should appear that the 

item is to be queried. A date entered after query is edited but accepted and will be 

transmitted to NCHS. 

STATE FILE CONSIDERATIONS 

While the paper document does not have separate fields for each element of the date of 

first or last prenatal care visit, the dates must be entered and stored as three separate 

fields. 

If states elect to use a data base system that has an option of storing dates as “date type 

variables,” then the system must meet the criteria listed under transmission standards. 

Dates that fail the edit criteria (that is, are more than one year earlier than the child’s date 

of birth) shall be changed to “unknown” before transmission to NCHS. 
Item 29a29b, page 6 

4/2004; Updated 3/18/2005 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAME LENGTH TYPE VALUES

DOFP_MO 2 Numeric 01-12, 88, 99 

DOFP_DY 2 Numeric 01-31, 88, 99 

DOFP_YR 4 Numeric 4 digit year, year of 

child’s birth or year-1, 

8888, 9999 

 

DOLP_MO 2 Numeric 01-12, 88, 99 

DOLP_DY 2 Numeric 01-31, 88, 99 

DOLP_YR 4 Numeric 4 digit year, year of 

Child birth or year–1, 

8888, 9999 

 

EDI TRANSMISSION: 

HL 7 transmission standards will be followed for the table. 

Format------YYYY[MM[DD]] 

Year must be fully represented with four digits. Software that stores dates as “date type” 

must be year 2000 compliant and capable of producing the date in the YYYY format and 

capable of producing messages in the HL7 EDI Format. 

DERIVED VARIABLES: 

Outlined below is the calculation for the derived variable “The Month Prenatal Care 

Began.” States should not keep or use the derived variable “Month Prenatal Care Began” 

as calculated below for any purpose other than editing. This variable is a crude 

calculation to be used only for editing. 

At a later date, NCHS will provide the method used by NCHS to impute the missing 

“day” for records for which the day of the date of the first visit is unknown. Although the 

imputed day and the derived variable will not, at least initially, be transmitted to NCHS, 

use of these standardized edits, and imputation and calculation methods will help to 

ensure that the variable is reported as comparably as possible across reporting 

areas.

. 

CALCULATION OF “THE MONTH PRENATAL CARE BEGAN”
Item 29a29b, page 7 

4/2004; Updated 3/18/2005 

The month of prenatal care is calculated using the “Date of Last Menstrual Period” 

(where available) and the “Date of First Prenatal Care Visit” item. 

The following algorithm is used to calculate the item “The Month Prenatal Care Began.” 

1. Convert to century dates the Date Last Menstrual Period Began (CDLMP) and Date of 

the First Prenatal Visit (CDPV) as follows: 

 CDPV= (365*YYYY)+DY 

Where YYYY is the four digit year of the first prenatal care visit 

DY is the number of days in the year prior to the beginning of the month of the 

date of first prenatal care visit + the day of the first prenatal care visit. (If the day 

is not known it will be imputed according to a method to be provided). 

 

Month #Prior Days* Month #Prior Days* 

January 0 July 181 

February 31 August 212 

March 59 September 243 

April 90 October 273 

May 120 November 304 

June 151 December 334 

* In leap years add 1 to all numbers March-December 

Example 

 Date of first prenatal care visit: April 10, 2003 

 Date of LMP is March 1, 2003 

 CDPV=(365*2003)+(90+10)=731195 

 CDLMP=(365*2003)+(59+1)=731155 

1.Obtain the number of days between date of last LMP and date of first prenatal care 

visit. 

 Days=CDPV-CDLMP 

 Days=731195-731155 

 Days=40 

2. Convert days to months of pregnancy. 

Assume each month has 30.4 days (365/12) and use the following table: 
Item 29a29b, page 8 

4/2004; Updated 3/18/2005 

Days Month 

1-30 1st

31-61 2nd

62-91 3rd

92-122 4th

123-152 5th

153-182 6th

183-213 7th

214-243 8th

244-274 9th

275-304 10th

305+ 99 (unknown) 

In this example the “Month Prenatal Care Began would be the 2nd month and 

assigned the value “2". 

If the month and day of LMP date are missing, use obstetric estimate of gestation 

(OE) in weeks and use in place of CDLMP the variable CD(OE) calculated as 

follows: 

 Calculate century date of birth as above and then 

 CD(OE)=CD(date of birth)-(OE*7) 

 (Example to be included.) 

In this situation if obstetric estimate is unknown, assign the “unknown” code 99. 

In all cases : 

If the year of first prenatal care visit is unknown, assign the “unknown” code 99 

for this derived variable . 

If the mother had no prenatal care, assign the “no prenatal care” code 88 for this 

derived variable.
Item 30, page 1 

4/2004; Updated 3/18/2005 

Item Title: TOTAL NUMBER OF PRENATAL CARE 

VISITS FOR THIS PREGNANCY

Item Number: 30 Certificate, 7 Facility worksheet

 

Description: Those visits which are listed in the mother’s prenatal care 

and/or facility records 

Source of Information: 

Preferred Source: Prenatal care record 

 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

If the mother had no prenatal care, type or print “0” in the space. Note: the “no prenatal 

care” box should also be checked in item 29. 

If the mother had prenatal care but the number of visits is not known, type or print 

“unknown” in the space. 

 

Type or print the total number of prenatal care visits for this pregnancy in the space. 

TOTAL NUMBER OF PRENATAL VISITS FOR THIS PREGNANCY 

 _________________(If none, enter “0”) 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics) 

When the number of prenatal care visits is to be entered, it is critical that the 

recommended message screens also appear. 

Please enter the total number of prenatal care visits listed in the mother’s records. 

Total number of prenatal care visits _______ 

The following message should also appear: 
Item 30, page 2 

4/2004; Updated 3/18/2005 

Check this button if the information needed to complete the number of 

prenatal care visits is currently not available, but an effort is being made to 

obtain it. 

 Information not currently available 

EBR developers may wish to use a hot key for responding to the above rather than a 

specific button. For example the instruction could read: 

Press the ______key if the information needed to complete this item is currently 

not available, but an effort is being made to obtain it. 

When this button is checked, the item is skipped and placed in pending status for 

completion at a later time. The following message will appear. 

Please check the mother’s prenatal care record and/or facility records to obtain the 

number of prenatal care visits. 

An entry for this item is required if the “no prenatal care” check box in item 29 is not 

marked. If the “no prenatal care” check box was marked in item 29, this screen is 

skipped and “0” automatically entered. 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

NPREV Number of prenatal 0-98,99 Number within range 

 care visits 

NPREV_BYPASS Edit flag 0 OFF (edit passed) 

 1 ON (edit failed, number verified) 

2 ON (edit failed, number not verified) 

DNA30 Pending flag 0 OFF 

 1 ON 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

If the data not available at this time box is checked, the pending flag is set to ON-1, the 

number of visits is assigned the “unknown” code and the edits are skipped. The data item 

will appear on the final review screen. 
Item 30, page 3 

4/2004; Updated 3/18/2005 

If number of visits is “0,” the box for no prenatal care in item 29 must be checked. If the 

box is not checked and there is a date in the “date of first prenatal care visit” field, a 

message should appear indicating the inconsistency and asking that it be resolved. 

See example below: 

Item 29 indicates that the mother did have prenatal care. Therefore, the number of 

prenatal care visits must be greater than “0.” Please enter the correct total below: 

Number of prenatal visits____________ 

 Check this box if mother did not have any 

prenatal care.

If this box is checked, a message should appear indicating that this response is 

inconsistent with the entry for item 29. A review screen for item 29 then appears. 

If the number of prenatal visits is greater than 49 and not “99,” a query message should 

appear indicating that the number of visits is greater than 49. 

The record shows the number of prenatal care visits is _________ 

 Please check this box if this number is correct. 

If this box is checked, the edit bypass flag is set to ON-1 

If the number is incorrect, please enter the correct number____________ 

The edit is rerun with the new number. If the edit fails, the bypass flag is set to ON-2 

PAPER RECORD 

If the field is blank and item 29 indicates that there was prenatal care, query. If item 29 

indicates there was no prenatal care, assign the “0” code. 

After data entry, run the same edits as above for the electronic record. 

NCHS TRANSMISSION FILE 

VARIABLES: 

 NAME LENGTH TYPE VALUE

NPREV 2 Numeric 0-98,99 

 

 
Item 30, page 4 

4/2004; Updated 3/18/2005 

NPREV_BYPASS 1 Numeric 0,1,2 

 

EDI TRANSMISSION: 

No standards set yet 
Item 31, page 1 

4/2004; Updated 3/18/2005 

Item Title: MOTHER’S HEIGHT 

Item Number: 31 Certificate, 12 Mother’s worksheet

 

Description: The mother’s height 

 

Source of Information: 

Preferred Source: The mother 

Other Source: The mother’s medical record 

 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

If the mother’s height is unknown, print or type “unknown” in the space. 

Enter the mother’s height in feet and inches. If the record indicates height in fractions 

such as 5 feet 6 1⁄2 inches, truncate and enter 5 feet, 6 inches. 

MOTHER’S HEIGHT ___________(feet/inches) 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics) 

Height should be recorded in feet and inches. Enter whole inches only; truncate 

fractions of inches. The following instruction should appear when the item is to be 

completed. 

 

 Mother’s height____________(feet) and 

 ____________(inches) 

 Unknown 

Please enter height in feet and inches (for example, 5 feet, 6 inches). If no inches 

(for example, 5 feet only) enter the number of feet and “0” for inches. If the 

unknown box is checked, fill the feet field with 9 and the inches field with 99.
Item 31, page 2 

4/2004; Updated 3/18/2005 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUE DEFINITION

HFT Mother’s height feet 1-8 Feet 

 9 Unknown 

HIN Mother’s height inches 0-11 Inches 

 99 Unknown 

HGT_BYPASS Edit flag for height 0 OFF 

 1 ON (verified) 

 2 ON (not verified) 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

Values of 1,2 and 8 will be soft edited. If the mother’s height in feet is not between 3 and 

7, the following message should appear: 

You have entered a height of ______feet. Check the box below if this is correct, or 

re-enter height. 

 Height is correct 

Height______(feet) 

 ______(inches) 

Entries of 1 - 9 will be accepted as valid values if the keyer indicates that the height is 

correct.

If the correct box is checked, the bypass flag is set to ON-1. 

If a new value is entered, the edit is rerun and, if it fails, the bypass flag is set to ON-2 

The number of inches must be between 0 and 11 or 99,. Entries greater than 11 inches, 

except 99, will not be accepted (hard edit). 

If systems allow initial entries >11 the following message should appear: 

Please re-enter the number of inches. Inches must be between 0 and 11. 

 _______(inches) 
Item 31, page 3 

4/2004; Updated 3/18/2005 

PAPER RECORD 

Records filed with the item blank shall be queried. 

If there is no response to the query, assign the “unknown” code. 

If the item indicates “unknown,” assign the “unknown” code. 

If the response gives a range, enter the highest value. 

If the response gives a fraction like 5 feet 6 1⁄2 inches, enter only the whole number (6 

inches). 

State Edits of data file prior to NCHS transmission 

Must be valid codes and values. 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

 NAMES LENGTH TYPE VALUES

HFT 1 Numeric 1-8,9 

HIN 2 Numeric 0-11,99 

HGT_BYPASS 1 Numeric 0,1,2 

EDI TRANSMISSION: 

No standards set yet. 
Item 32, page 1 

4/2004; Updated 3/18/2005 

Item Title: MOTHER’S PREPREGNANCY WEIGHT 

 

Item Number: 32 Certificate, 13 Mother’s worksheet

Description: The mother’s prepregnancy weight 

 

Source of Information: 

Preferred Source: Mother 

Other Source: Mother’s Prenatal care record 

 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

If the mother’s prepregnancy weight is unknown, print or type “unknown” in the item’s 

space. 

Record weight in whole pounds only, do not include fractions. 

MOTHER’S PREPREGNANCY WEIGHT___________(pounds). 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics) 

The mother’s prepregnancy weight should be recorded in whole pounds only, truncate,; 

do not include fractions (e.g., 120 1⁄2 pounds should be entered as 120 pounds). The 

following item and instruction should appear: 

 Mother’s prepregnancy weight___________pounds. 

If weight is unknown, enter 999. 

EBR developers may wish to use “?” or a hot key for unknowns.

PROCESSING VARIABLES: 

 NAME DESCRIPTION VALUES DEFINITION
Item 32, page 2 

4/2004; Updated 3/18/2005 

PWGT Mother’s prepregnancy weight 50-400 

 999 unknown 

PWGT_BYPASS Edit flag for prepregnancy weight 0 OFF 

 1 ON (verified) 

 2 ON (not verified) 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

If mother’s prepregnancy weight is not between 75 and 300 pounds or 999 a message 

should appear that asks that the prepregnancy weight be verified. 

Please check the box or enter correct weight. 

 Weight is correct 

 Weight_________ 

If the correct box is checked, the bypass flag is set to ON-1. 

If a new value is entered, the edit is rerun and, if it fails, the bypass flag is set to ON-2. 

Values less than 50 and greater than 400 should be converted to unknown (999). 

PAPER RECORD 

Records filed with the item blank shall be queried. 

If there is no response to the query, assign the “unknown” code. 

If the item indicates “unknown,” assign the “unknown” code. 

If a response gives a range, enter the highest value given. 

If a response gives a fraction, truncate and enter only the whole number (e.g., 120 1⁄2 

pounds should be reported as 120 pounds.) 

State Edits of data file prior to NCHS transmission 

Must be valid codes and values. 
Item 32, page 3 

4/2004; Updated 3/18/2005 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

 NAME LENGTH TYPE VALUE

PWGT 3 Numeric 50-400, 999 

PWGT_BYPASS 1 Numeric 0,1,2 

 

EDI TRANSMISSION: 

 

No standards set yet. 
Item 34, page 1 

4/2004; Updated 3/18/2005 

Item Title: MOTHER’S WEIGHT AT DELIVERY 

Item Number: 33 Certificate, 26 Facility worksheet 

 

Description: The mother’s weight at the time of delivery

Source of Information: 

Preferred Sources: Labor and Delivery records, Admission history and 

 physical 

 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

If the mother’s delivery weight is unknown, print or type “unknown” in the item’s space. 

Record weight in whole pounds only, do not include fractions. 

MOTHER’S WEIGHT AT DELIVERY________(pounds) 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics) 

Weight should be recorded in whole pounds only, truncate, do not include fractions (e.g. 

140 1⁄2 pounds should be entered as 140 pounds). The following item and instruction 

should appear: 

Mother’s weight at delivery___________pounds. 

If weight is unknown, enter 999. 

PROCESSING VARIABLES: 

 NAME DESCRIPTION VALUES DEFINITION

DWGT Mother’s weight at delivery 50-450 

 999 unknown 

DWGT_BYPASS Edit flag for delivery weight 0 OFF 

 1 ON (verified) 

2 ON (not verified) 
Item 34, page 2 

4/2004; Updated 3/18/2005 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

If mother’s weight at delivery is not between 75 and 350 pounds (or 999), a message 

should appear asking that the delivery weight be verified. 

Please check the box or enter correct weight. 

 Weight is correct 

 Weight_________ 

If the correct box is checked, the bypass flag is set to ON-1. 

If a new value is entered, the edit is rerun and, if it fails, the bypass flag is set to ON-2 

Values less than 50 and greater than 450 should be converted to unknown (999). 

PAPER RECORD 

Records filed with the item blank shall be queried. 

If there is no response to the query, assign the “unknown” code. 

If the item indicates “unknown,” assign the “unknown” code. 

If the response gives a range, enter the highest value given. 

If a response gives a fraction of a pound, enter only the whole number (e.g., 140 1/2 

pounds should be reported as 140 pounds.) 

State Edits of data file prior to NCHS transmission 

Must be valid codes and values. 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

 NAME LENGTH TYPE VALUE

DWGT 3 Numeric 50-450,999 

DWGT_BYPASS 1 Numeric 0,1,2 

 

EDI TRANSMISSION: 
Item 34, page 3 

4/2004; Updated 3/18/2005 

No standards set yet. 
Item 34, page 1 

4/2004; Updated 3/18/2005 

Item Title: DID MOTHER GET WIC FOOD FOR 

HERSELF DURING THIS PREGNANCY? 

 

Item Number: 34 Certificate, 11 Mother’s worksheet

 

Description: Use of the Women, Infant’s and Children (WIC) 

nutritional program by the mother during the pregnancy 

Source of Information: 

 Preferred Source: Mother 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

This item is to be completed based on information obtained from the mother. Either the 

“yes” or “no” box must be checked. 

If the mother’s work sheet indicates “unknown,” print or type “unknown.” 

DID MOTHER GET WIC FOR HERSELF DURING THIS PREGNANCY? 

 Yes  No 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics) 

The item should be completed by keying the response recorded on the mother’s work 

sheet. The following list of choices should be provided. 

 Yes 

 No 

 Unknown 
Item 34, page 2 

4/2004; Updated 3/18/2005 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

 

WIC Mother’s use of the Y Yes 

 WIC program N No 

 U Unknown 

 

EDITS: 

ELECTRONIC RECORD 

The field cannot be blank. 

PAPER RECORD 

Records filed with this item blank shall not be queried unless the record is being queried 

for another item. 

If the item is blank and not queried, the “not classifiable” code shall be assigned. 

If the item indicates “unknown,” assign the “not classifiable” code. 

State Edits of data file prior to NCHS transmission 

Must be valid codes. 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

NAME LENGTH TYPE VALUES

WIC 1 Alpha character string Y, N, U 

 

EDI TRANSMISSION: 

 

No standards set yet. 
Item 35,36, page 1 

4/2004; Updated 3/18/2005 

Item Titles: NUMBER OF PREVIOUS LIVE BIRTHS 

 NOW LIVING 

 NUMBER OF PREVIOUS LIVE BIRTHS 

 NOW DEAD 

 DATE OF LAST LIVE BIRTH 

NUMBER OF OTHER PREGNANCY 

 OUTCOMES 

DATE OF LAST OTHER PREGNANCY 

 OUTCOME 

Item Numbers: 35 a-c, 36 a-b Certificate; 

9, 10, 11, 12, 13 Facility worksheet 

Description: The pregnancy history of the mother with respect to 

previous children born alive. 

The pregnancy history of the mother with respect to other 

pregnancy outcomes (includes pregnancy losses of any 

gestational age, e.g., spontaneous or induced losses or 

ectopic pregnancies). 

Source of Information: 

Preferred Source: Prenatal care record 

Other Source: Labor and delivery nursing admission triage form, 

Admission history and physical 

INSTRUCTIONS 

FOR A PAPER RECORD: 

When completing this item, do not include this birth; include all previous live born 

infants. For multiple deliveries, include all live born infants preceding this infant in the 

delivery. If first born in a multiple delivery, do not include this infant. If second born, 

include the first born, etc. 

Please type or print the number of previous live born infants still living in item 35a, the 

number born alive now dead in item 35b, and the number of other pregnancy outcomes in 

item 36a. If there were none check the “none” boxes. If the number is unknown, type or 

print “unknown” in the space. 
Item 35,36, page 2 

4/2004; Updated 3/18/2005 

NUMBER OF PREVIOUS LIVE BIRTHS / OTHER PREGNANCY OUTCOMES 

(Do not include this child) 

35a. Now Living 35b. Now Dead 36a. Other Outcomes 

Number_______ Number_______ Number________ 

 None  None  None 

If applicable, type or print the month and year of birth of the last live born infant in item 

35c. 

If the date of birth is not known, type or print “unknown” in the space. 

35c. DATE OF LAST LIVE BIRTH 

 ________/_____________ 

 MM YYYY 

 

If applicable, type or print the month and year of delivery of the last other pregnancy 

outcome in item 36b. 

If the date of delivery is not known, type or print “unknown” in the space. 

36b. DATE OF LAST OTHER PREGNANCY OUTCOME 

 ________/_____________ 

 MM YYYY 

FOR AN ELECTRONIC RECORD: 

EBR Developer: (Instructions are in Italics) 

 

When the pregnancy history items are to be entered, it is critical that the recommended 

message screens appear when appropriate. 

The following message should appear first: 

Check this button if the information needed to complete the pregnancy 

history items is currently not available, but an effort is being made to obtain 

it. 

 Information not currently available 
Item 35,36, page 3 

4/2004; Updated 3/18/2005 

EBR developers may wish to use a hot key for responding to the above rather than a 

specific button. For example the instruction could read: 

Press the ______key if the information needed to complete this item is currently 

not available, but an effort is being made to obtain it. 

When this button is checked, the item is skipped and placed in pending status for 

completion at a later time. The following message will appear.

Please check the mother’s prenatal care record and/or hospital record to obtain the 

number of previous live births and other pregnancy outcomes. 

This item is to be completed by the facility. If the birth did not occur in a facility, it is to 

be completed by the attendant or certifier. 

Allow only 2 digit fields for entering responses to each of the three items: the number of 

previous live births now living, number of previous live births now dead, and number of 

other previous pregnancy outcomes. 

The following message should appear. 

When completing this item, do not include this birth. Do include any previous live 

born infants. If this was a multiple delivery, include all live born infants who 

preceded the live born infant in this delivery. If first born, do not include this infant. 

If second born, include the first born. Also include all live born infants in previous 

deliveries. 

Number of previous live births now living __________ 

 None 

 Unknown 

 

Number of previous live births now dead__________ 

 None 

 Unknown 

Number of other pregnancy outcomes_________ 

 None 

 Unknown 

In lieu of the checkbox for “unknown” the EBR developer may choose to use “hot keys” 

or other symbols for unknown values. 

If there are any previous live born infants the following message should appear. 
Item 35,36, page 4 

4/2004; Updated 3/18/2005 

Month and year of the last live birth. 

Month ____ ____ 

 Year ____ ____ ____ ____ 

 Unknown 

If there were no previous live born infants the message above will not appear nor will the 

entry screen. The field will automatically be completed with the “not applicable” code. 

The year must be at least the mother’s year of birth plus 10 years. 

If there are any other pregnancy outcomes, the following message should appear. 

Month and year of the last other pregnancy outcome. 

Month ____ ____ 

 Year ____ ____ ____ ____ 

 Unknown

If there were no other pregnancy outcomes, the message above will not appear, nor will 

the entry screen. The field will automatically be completed with the “not applicable” 

code. 

The year must be at least the mother’s year of birth plus 10 years. Values outside of this 

range should be converted to unknown (9999). 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINTION

PLBL Previous live births now living 00-30,99 Number 

PLBD Previous live births now dead 00-30,99 Number 

POPO Previous other pregnancy outcomes 00-30,99 Number 

MLLB Month last live birth 01-12,88,99 Month number 

YLLB Year last live birth 4 digit year, 

8888,9999 Year number 

 (Mother’s year 

of birth plus 

10, through 

child’s year of 

birth) 

MOPO Month last other pregnancy outcome 01-12,88,99 Month number 

YOPO Year other pregnancy outcome 4 digit yr, 

8888,9999 Year number 

 (Mother’s 
Item 35,36, page 5 

4/2004; Updated 3/18/2005 

year of birth 

plus 10, 

through 

child’s year of 

birth) 

LBO Live birth order 00-30,99 Number 

TBO Total birth order 00-40,99 Number 

C_AGEM Mother’s calculated age 10-64 Number 

DNA Pending flag 0 OFF 

 1 ON 

88,8888 Not applicable 

99,9999 Unknown 

The not applicable codes are used in the date fields when there were either no previous 

live births or no previous other pregnancy outcomes. 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

If the data are not available at the time box is checked, the pending flag is set to ON-1, 

all the other variables are assigned the “unknown” codes and the edits are skipped. The 

data item will appear on the final review screen. 

Once an entry is made in each item, the next field appears. This prevents both a box 

being checked and a number being entered. 

If any of the “none” boxes are checked, fill the appropriate number field(s) with 00. 

If any of the “unknown” boxes are checked, fill the number field(s) with 99 (“unknown”). 

If a “none” box is not checked and the “unknown” box is not checked and there is no 

number in the number field, the original entry screen with the message, Please complete 

this item should appear. 

If “00” is entered or assigned for any of these fields the date fields must contain the “not 

applicable” codes. 

Once these edits are done the fields are further edited. 

If value of the field(s) is not 99 but >12, the following message should appear: 

The record indicates that the number 

of previous born children still living is ______. 
Item 35,36, page 6 

4/2004; Updated 3/18/2005 

 correct 

If incorrect, enter the correct number._____ 

The record indicates that the number 

of previous live born children now dead is ______. 

 correct 

If incorrect, enter the correct number._____ 

The record indicates that the number 

of other pregnancy outcomes is ______. 

 correct 

If incorrect, enter the correct number._____ 

If the correct box is checked and the number is greater than 30, assign 99 to the 

appropriate variable. 

Compute the live birth order as follows: LBO = PLBL+PLBD+1 

If the value is 99 for either PLBL or PLBD assign 99 to the variable LBO. 

Compute the total birth order as follows: TBO=LBO+POPO 

If the value is 99 for the POPO or LBO, assign 99 to variable TBO. 

Check for consistency of live birth order and calculated age of mother as follows 

C_AGEM-LBO must be ≥ 8. 

If this value is < 8, the following message appears 

The mother is _______years of age and the record indicates: 

 ________Previous live births living 

 ________Previous live births now dead 

 correct 
Item 35,36, page 7 

4/2004; Updated 3/18/2005 

If incorrect, enter the correct number(s) 

Previous live births living_______ 

Previous live births now dead_____ 

The calculation is redone, and if the edit fails, assign the value 99 to the variables LBO 

and TBO. If this edit fails, the following check is not done. 

Check for consistency of total birth order and calculated age of mother as follows: 

C_AGEM-TBO must be ≥8. 

If this value is less than 8, the following message appears 

The mother is _______years of age and the record indicates: 

 ________Previous live births living 

 ________Previous live births now dead 

 ________Previous other pregnancy outcomes 

 correct 

If incorrect, enter the correct number(s) 

Previous live births living_______ 

 Previous live births now dead______ 

 Previous other pregnancy outcomes_______ 

The calculation is redone, and if the edit fails, assign the value 99 to the variable TBO. 

Any value for the LBO > 30, except 99, is changed to 99. 

Any value for the TBO> 40, except 99, is changed to 99 

Date fields must be checked for valid values. In addition, year must be less than or equal 

to year of current event. If the record indicates that any of the number fields contains a 

value other than 00, 99, and the date field “unknown” box is not checked and both parts 

of the date field are blank, a message should appear that reads: 

Please enter the date or check the “unknown” box. 

The appropriate entry screen should appear. 

PAPER RECORD 
Item 35,36, page 8 

4/2004; Updated 3/18/2005 

If the fields are blank, query. If no response to query, assign 99 to the field. 

Same edits are run as above. If edits fail, record is queried. If response to query contains 

new values that fail the edit, set values as indicated above for the EBR. If the response 

indicates the values are correct set the values to 99 for any values that are greater than 30. 

If there are numbers for any of the three events and no date entered and unknown is not 

written in the space, query. If no response to query, set date fields to “99” and “9999.” 

State Edits of data file prior to NCHS transmission 

See above edits for electronic records. 

Must have valid codes (see below). 

STATE DATA FILE CONSIDERATIONS 

States should keep the LBO and TBO calculated variables in their files for tabulation 

purposes. Numeric fields of 2 digits each should be reserved for these variables. 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

NAME LENGTH TYPE VALUES

PLBL Previous live births now living 2 Numeric 00-30,99 

PLBD Previous live births now dead 2 Numeric 00-30,99 

POPO Previous other pregnancy outcomes 2 Numeric 00-30,99 

MLLB Month last live birth 2 Numeric 01-12, 

 88, 99 

YLLB Year last live birth 4 Numeric 4 digit yr 

(Mother’s year of 

birth plus 10 yrs 

through child’s year 

of birth), 8888,9999 

 

 

MOPO Month last other pregnancy outcome 2 Numeric 01-12 

 88, 99 

YOPO Year other pregnancy outcome 4 Numeric 4 digit yr 

(Mother’s year of 

birth plus 10 yrs 

through child’s year 

of birth), 8888,9999 
Item 35,36, page 9 

4/2004; Updated 3/18/2005 

EDI TRANSMISSION: 

 

No standards set yet. 
Item 37, page 1 

4/2004; Updated 3/18/2005 

Item Title: CIGARETTE SMOKING BEFORE AND 

DURING PREGNANCY 

Item Number: 37 Certificate, 14 Mother’s worksheet

Description: The number of cigarettes or packs of cigarettes the 

mother smoked 3 months before and at various intervals 

during the pregnancy 

Source of Information: 

Preferred Source: Mother 

 

INSTRUCTIONS* 

* States that implemented the 2003 revision of the birth certificate and fetal death report prior to 2005 may 

have adopted editing specifications that were consistent with the version of the certificate and report in 

effect through October 2003, that is the version that was initially recommended by the Panel to Evaluate 

the U.S. Standard Certificates and Reports (http://www.cdc.gov/nchs/vital_certs_rev.htm). The standard 

certificates and report have now been officially cleared and promulgated by the U.S. Department of Health 

and Human Services, effective November 2003, and incorporate modest changes in some items, including 

this item. States which revise their certificates and report for 2005 and later years are expected to use these 

specifications (dated 3/2005) that reflect the content of the cleared certificates. 

For item 37, the original version of the birth certificate had the last response category as "last three months 

of pregnancy." During the clearance process that wording was revised; on the final version of the fetal 

death report, the last response category for item 37 now reads "third trimester of pregnancy." 

FOR A PAPER RECORD: 

 

This item is to be completed by the facility based on information obtained from the 

mother. If the birth did not occur in a facility, it is to be completed by the attendant or 

certifier based on information obtained from the mother. 

If the mother’s work sheet indicates “unknown,” or “refused” print or type “unknown.” 

Enter either the average number of cigarettes or the average number of packs of cigarettes 

smoked for each time period. 

CIGARETTE SMOKING BEFORE AND DURING PREGNANCY 

For each time period enter either the number of cigarettes or the number of packs of 

cigarettes smoked. If none enter “0.” 

Average number of cigarettes or packs of cigarettes smoked per day. 
Item 37, page 2 

4/2004; Updated 3/18/2005 

 # of cigarettes # of packs 

Three Months Before Pregnancy ___________ OR __________ 

First Three Months of Pregnancy ___________ OR __________ 

Second Three Months of Pregnancy ___________ OR __________ 

Third Trimester of Pregnancy ___________ OR __________ 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

The item should be completed by keying the response recorded on the mother’s work 

sheet. The following message and screen format is suggested: 

Check whether the mother reported in cigarettes or packs. If both cigarettes and 

packs are given, enter in packs: 

 Cigarettes 

 Packs 

Enter the average number of cigarettes or packs of cigarettes smoked per day for 

each time period. If none enter “0.” If no part of the item is completed, check 

“unknown.” If a range is given enter the highest number. 

If the number of cigarettes is checked the following screen will appear: 

Enter the number of cigarettes shown on the worksheet. 

 Number of cigarettes 

Three months before pregnancy ___________ 

First three months of pregnancy ___________ 

Second three months of pregnancy ___________ 

Third Trimester of Pregnancy ___________ 

 Unknown 

If the number of packs is checked the following screen will appear: 

 Number of packs 
Item 37, page 3 

4/2004; Updated 3/18/2005 

Enter the number of whole packs and/or check any fraction of a pack as shown on 

the worksheet. 

Three months before pregnancy __________  1⁄4 1⁄2 3⁄4 

First three months of pregnancy ___________ 1⁄4 1⁄2 3⁄4 

Second three months of pregnancy ___________ 1⁄4 1⁄2 3⁄4 

Third Trimester of Pregnancy ___________ 1⁄4 1⁄2 3⁄4 

 Unknown 

The entry of only a fraction of a pack is allowed. 

Any complete numbers of packs of 0-4 should be multiplied by 20 and added to the 

number of cigarettes field for each trimester to sum the total “number of cigarettes 

variable” for each trimester. 

The system should convert fractions of packs to number of cigarettes as follows: 1⁄4=5; 

1⁄2=10; 3⁄4=15. The resulting number should then be added to the total number of 

cigarettes for each trimester. Once this is completed, the pack variables need not be 

carried forward; will not be transmitted to NCHS. 

Values for packs equal to or greater than “5” should be converted to “98” cigarettes. 

If the” unknown” box is checked, assign “99” to the four variables: 

CIGPN, CIGFN, CIGSN, CIGLN. 

PROCESSING VARIABLES: 

 NAME DESCRIPTION VALUE

CIGPN Number cigarettes smoked prior to pregnancy 0-98, 99 

CIGPP Number of packs smoked prior to pregnancy 0.00-5.00 

CIGFN Number of cigarettes smoked in 1st three months 0-98, 99 

CIGFP Number of packs smoked in 1st three months 0.00-5.00 

CIGSN Number of cigarettes smoked in 2nd three months 0-98, 99 

CIGSP Number of packs smoked in 2nd three months 0.00-5.00 

CIGLN Number of cigarettes smoked in third trimester 0-98, 99 

CIGLP Number of packs smoked in third trimester 0.00-5.00 

 Unknown (all variables) 99 

EDITS: 

ELECTRONIC RECORD 
Item 37, page 4 

4/2004; Updated 3/18/2005 

The variables CIGPN, CIGFN, CIGSN, CIGLN must have valid entries of 00-98, 99. 

PAPER RECORD 

Records filed with this item blank shall be queried. 

If the item is blank and not queried, the “unknown” code shall be assigned. 

If the item indicates “unknown,” assign the “unknown ” code to each of the “number 

variables.” 

If the item indicates “refused,” assign the “unknown” code to each of the “number 

variables.” 

Use pack responses in preference to number of cigarette responses when there are entries 

in both for the same variable. 

If a fraction is entered on the document like 2 1⁄2 packs, use the conversion table below 

for entry. For the example, enter the decimal number “2.50.” 

1⁄4=0.25; 1⁄2=0.50; 3⁄4=0.75 

The number of packs is converted to the number of cigarettes by multiplying by 20 and 

assigning the resulting value to the corresponding number of cigarettes variable. 

State Edits of data file prior to NCHS transmission: 

Must be valid codes. 

STATE FILE CONSIDERATIONS 

States may elect to add a “never smoked” checkbox to this item. If so, this checkbox 

should be placed at the very end of the question. States should note that the inclusion of 

a “never smoked” checkbox may result in data which is not comparable to national data 

or to that of other States which do not include this checkbox.

NCHS TRANSMISSION FILE 

 

VARIABLES: 

 NAME LENGTH TYPE VALUE
Item 37, page 5 

4/2004; Updated 3/18/2005 

CIGPN 2 Numeric 0-98, 99 

CIGFN 2 Numeric 0-98, 99 

CIGSN 2 Numeric 0-98, 99 

CIGLN 2 Numeric 0-98, 99 

EDI TRANSMISSION: 

 

No standards set yet. 
Item 38, page 1 

4/2004; Updated 3/18/2005 

Item Title: PRINCIPAL SOURCE OF PAYMENT FOR 

THIS DELIVERY 

Item Number: 38 Certificate, 22 Facility worksheet 

 

Description: The principal payer for this delivery 

Source of Information: 

Preferred Source: Hospital face sheet, Admitting office face sheet 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

This item is to be completed by the facility. If the birth did not occur in a facility, it is to 

be completed by the attendant or certifier. 

Please check the one box that best describes the principal source of payment for this 

delivery. If the “Other (Specify)” box is selected, please specify the payer. 

If the principal source of payment is not known, print or type “unknown” in the space. 

PRINCIPAL SOURCE OF PAYMENT FOR THIS DELIVERY 

 Private Insurance 

 Medicaid 

 Self-pay 

 Other (Specify)_____________ 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in italics)

This item is to be completed by the facility. If the birth did not occur in a facility, it is to 

be completed by the attendant or certifier. 
Item 38, page 2 

4/2004; Updated 3/18/2005 

The principal source of payment for this delivery is to be selected from the following: 

 Medicaid 

 Private Insurance (Blue Cross/ Blue Shield, Aetna, etc.) 

 Self-pay 

 Other (Specify)_________________ 

 Unknown 

State may also chose to expand this item to include common payment sources such as 

those listed below in addition to State-specific sources. If any of these additional sources 

listed below are captured, please assign values as shown under “processing variables.” 

 Indian Health Service 

 CHAMPUS/TRICARE 

 Other government (federal, state, local) 

PROCESSING VARIABLES: 

 

NAME DESCRIPTION VALUES DEFINITION

PAY Principal source of payment for 1 Medicaid 

 delivery 2 Private Insurance 

3 Self-pay 

4 Indian Health Service 

5 CHAMPUS/ 

TRICARE 

6 Other government 

(federal, state, local) 

8 Other 

9 Unknown 

EDITS: 

ELECTRONIC RECORD 

Only one source of payment may be selected. This item may not be blank; the record 

cannot be filed or printed until the item is completed. 

PAPER RECORD 

Records filed with the source of payment blank should be queried. If no response to 

query, enter “unknown” in the “other specify” location. 

If the “Other specify”indicates any of those listed, code as shown above. All other 
Item 38, page 3 

4/2004; Updated 3/18/2005 

entries code to “Other.” 

States can develop a coding scheme for responses other than those listed, but all 

responses except “unknown” should be converted to the “Other” code for transmission to 

NCHS. 

State Edits of data file prior to NCHS transmission 

See above edits for electronic records. 

STATE FILE CONSIDERATIONS 

State offices can design their software to maintain the other specified response codes and 

expand the list to meet their needs. 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAME LENGTH TYPE VALUES

PAY 1 Numeric 1,2,3,8,9 

(4,5,6 if States elect to collect the 

expanded list) 

 

EDI TRANSMISSION: 

No standards set yet. 
Item 39, page 1 

4/2004; Updated 3/18/2005 

Item Title: DATE LAST NORMAL MENSES BEGAN

Item Number: 39 Certificate, 8 Facility worksheet

 

Description: Date that the mother’s last normal menses began. This 

item is used to compute the gestational age of the infant.

Source of Information: 

 Preferred Source: Mother’s prenatal care record 

 Other Source: Admission history and physical 

 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Print or type all parts of the date that the mother’s last normal menses began. 

If no parts of the date are known, write in “unknown.” 

DATE LAST NORMAL MENSES BEGAN 

______/_______/________ 

 MM DD YYYY 

 

FOR AN ELECTRONIC RECORD: 

EBR Developer: (Instructions are in Italics) 

The date last normal menses began must be a three-field entry with month day and year 

being entered in separate fields. 

The following message should appear first:

Check this button if the information is not yet available from one of the source 

documents. (This should be indicated on the facility work sheet) 

 Information not currently available 

If this button is checked, the item is skipped and placed in a pending status for 

completion at a later time. See final review screen. 
Item 39, page 2 

4/2004; Updated 3/18/2005 

EBR developers may wish to use a hot key for responding to the above rather than 

a specific button. For example the message could read: 

Press the _____key if the information needed to complete this item is 

currently not available, but an effort is being made to obtain it. 

Each part of the three-part date field should be entered independently so any part 

of the date that is known is captured. The instructions below should appear when 

the date is to be completed: 

 Complete ALL PARTS of the date that are available. 

 Key all 9s for any parts of the date that are not known. 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

DLMP_YR Year of last menstrual period 4 digit year 

 9999 Values of 99, and 9999 

DLMP_MO Month of last menstrual period 01-12, 99 are “unknown” codes. 

DLMP_DY Day of last menstrual period 01-31, 99 All other numeric 

values represent 4 digit 

years, or standard month 

and day numbers. 

 

DERIVED VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

CM_DLNM Century month last menstrual period 24024+, 88888 Values of 88, and 8888 are 

C_GESTM Months gestation 4-11, 88 “not computable” codes. 

CM_DOB Century month date of birth 24024+, 88888 They are assigned to derived 

 variables when information 

that is needed in computing the 

derived variable is not available or 

incorrect. 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

If the “data are not available at this time” button is checked, all the date fields are set to 

the “unknown” code “99,9999 ” and the item is put on the pending list for completion at 

a later time. No further edits are done. 
Item 39, page 3 

4/2004; Updated 3/18/2005 

If one or more of the date fields are completed they are checked against the values below. 

Entry Values 

. Month 01,02,03,04,05,06,07,08, 

 09,10,11,12, 99 

 

 

 Day 01 1-31, 99 

 02 1-29, 99 

 03 1-31, 99 

 04 1-30, 99 

 05 1-31, 99 

 06 1-30, 99 

 07 1-31, 99 

 08 1-31, 99 

 09 1-30, 99 

 10 1-31, 99 

 11 1-30, 99 

 12 1-31, 99 

Year Must be equal to the child’s 

year of birth or 1-2 years less, 

or 9999. 

. 

Any blanks will be automatically converted to the appropriate “unknown” codes; “99” 

or “9999.” 

If any of the edits fail, error messages and instructions will appear that show all the date 

information entered and a comment on invalid entries. These errors must be corrected 

before the record can be filed or printed. If the edit on DLMP_YR still fails the edit after 

reentry then set all values of the date field to the unknown codes. 

If February (02) day =29, year should be a leap year. The date of birth field must be 

compared with the date last normal menses began to be sure the date last normal menses 

began is earlier than the child’s date of birth. If not, a message should appear and 

request that the inconsistency be resolved. 

Derived Variable for Editing Purposes 

The century month of the date last normal menses began should be computed and stored 

as a five digit numeric field (CM_DLNM) as follows: 

If either the month or year of date last normal menses began is invalid or unknown, 

assign “88888” to the CM_DLNM variable. 
Item 39, page 4 

4/2004; Updated 3/18/2005 

Otherwise, compute CM_DLNM as: ((12 * year last normal menses) + month of last 

normal menses). 

Compute the period of gestation in months as follows: C_GESTM= CM_DOB - 

CM_DLNM. If either or both CM_DOB or CM_DLNM is “88888” set the C_GESTM 

(computed gestation, months)= “88.” If the computed interval is negative subtract 12 

from CM_DLNM and re-compute. This could occur if the month of DLNM is greater 

than the month DOB and the years are the same. This error should have been caught in 

the previous edit. But if it occurs subtract 1 year from the DLNM and replace with the 

new value. 

If C_GESTM is <0, (after the re-computation above) a message should appear that 

reads: 

The date of the last normal menses does not agree with other items. Please 

check and re-enter. 

The edit is rerun and if the edit still indicates that the interval is less than 0, the following 

message should appear. 

The infant’s gestation age still is less than 0, please check and re-enter the 

child’s date of birth. 

The edit is rerun and fails again, assign “88” to C_GESTM.

If the computed gestation is < 4 or >11, one of the following messages appears: 

Date of last normal menses as keyed does not agree with other items. Please check 

the dates listed below to be sure they were entered correctly. If there are errors, 

please re-enter the date(s). 

The computation is re-run and if it still fails the edit, C_GESTM variable is assigned the 

value of “88.” 

If the final edit screen indicates that all of the date of last normal menses is unknown, 

assign “99” to the day and month fields, and “9999” to the year field. Assign “88” to 

the computed gestation field and “8888” to the Century month of last normal menses. 

Values for DLMR_YR greater than 2 years different from child’s date of birth should be 

converted to unknown. 

PAPER RECORD 
Item 39, page 5 

4/2004; Updated 3/18/2005 

If date of last normal menses field is blank, query. If there is no response to query or 

response is “unknown,” assign the “not classifiable” code to each field. 

Carry out the above edits for an electronic record after data entry 

 

STATE FILE CONSIDERATIONS

State data files must contain space for the computed gestation in months although these 

data are not transmitted to NCHS. This is not the computed gestation to be used for 

statistical purposes. 

If states elect to use a data base system that has an option of storing dates as “date type 

variables,” the system must meet the criteria listed under transmission standards. 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

NAME LENGTH TYPE VALUES

DLMP_YR 4 Numeric 4 digit year, child’s 

yr of birth or 1 or 2 

years less, 9999 

DLMP_MO 2 Numeric 01-12, 99 

DLMP_DY 2 Numeric 01-31, 99 

 

EDI TRANSMISSION: 

HL 7 Transmission standards will be followed . This is a time date stamped standard in 

the following format: 

 YYYY[MM[DD]] 

Year must be fully represented with four digits. 

Software that stores dates as “date type” must be year 2000 compliant and capable of 

producing the date in the YYYY..... format and capable of producing messages in the 

HL7 EDI format. 
Item 41, page 1 

4/2004; Updated 3/18/2005 

Item Title: RISK FACTORS IN THIS PREGNANCY

Item Number: 41 Certificate, 14 Facility worksheet

Description: Selected medical risk factors of the mother during this 

pregnancy 

Source of Information: 

 Preferred source: Mother’s prenatal care record 

Other sources: Labor and delivery nursing admission triage form, 

Admission history and physical, Delivery record 

INSTRUCTIONS* 

* States that implemented the 2003 revision of the birth certificate and fetal death report prior to 2005 may 

have adopted editing specifications that were consistent with the version of the certificate and report in 

effect through October 2003, that is the version that was initially recommended by the Panel to Evaluate 

the U.S. Standard Certificates and Reports (http://www.cdc.gov/nchs/vital_certs_rev.htm). The standard 

certificates and report have now been officially cleared and promulgated by the U.S. Department of Health 

and Human Services, effective November 2003, and incorporate modest changes in some items, including 

this item. States which revise their certificates and report for 2005 and later years are expected to use these 

specifications (dated 3/2005) that reflect the content of the cleared certificates. 

For item 41, the original version of the birth certificate had two response categories for the “hypertension” 

factor: “prepregnancy (chronic)” and “gestational (PIH, preeclampsia, eclampsia”. During the clearance 

process the response categories for hypertension were revised. On the final version of the birth certificate, 

the response categories for hypertension are: “prepregnancy (chronic),” “gestational (PIH, preclampsia),” 

and “eclampsia.” 

For item 41, the original version of the birth certificate included a checkbox for “vaginal bleeding during 

this pregnancy prior to the onset of labor.” During the clearance process that checkbox was deleted. The 

final birth certificate does not include this checkbox. 

For item 41, the original version of the birth certificate included this checkbox: “pregnancy resulted from 

infertility treatment.” During the clearance process two response categories were added to this risk factor. 

On the final version of the birth certificate, the checkbox was revised to read: “Pregnancy resulted from 

infertility treatment – If yes, check all that apply: __fertility-enhancing drugs, artificial insemination or 

intrauterine insemination; __assisted reproductive technology (e.g., in vitro fertilization (IVF), gamete 

intrafallopian transfer (GIFT)”

FOR A PAPER RECORD: 

The mother may have more than one risk factor, check all that apply. 

If the mother had none of the risk factors, check the “None of the above” box. 
Item 41, page 2 

4/2004; Updated 3/18/2005 

If it is unknown if the mother had any of the risk factors, type or print unknown. 

RISK FACTORS IN THIS PREGNANCY (Check all that apply): 

Diabetes 

 Prepregnancy (Diagnosis prior to this pregnancy) 

 Gestational (Diagnosis in this pregnancy)

Hypertension 

 Prepregnancy (Chronic)

 Gestational (PIH, preeclampsia)

 Eclampsia 

 Previous preterm births 

 Other previous poor pregnancy outcome (Includes, perinatal death, small for 

 gestational age/interuterine growth restricted birth) 

 Pregnancy resulted from infertility treatment – 

If Yes, check all that apply: 

 Fertility-enhancing drugs, artificial insemination or intrauterine insemination 

  Assisted reproductive technology (e.g., in vitro fertilization (IVF), 

 gamete intrafallopian transfer (GIFT)) 

 Mother had a previous cesarean delivery 

If yes, how many________ 

 None of the above 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics) 

The following definitions should appear in the help function: 

Diabetes (prepregnancy): Glucose intolerance requiring treatment diagnosed prior to this 

pregnancy. 

Diabetes (gestational): Glucose intolerance requiring treatment diagnosed during this pregnancy. 

Hypertension (prepregnancy): (Chronic) Elevation of blood pressure above normal for age, 

gender, and physiological condition diagnosed prior to the onset of this pregnancy. 

Hypertension (gestational): (PIH, Preeclampsia) Elevation of blood pressure above normal for age, 

gender, and physiological condition diagnosed during this pregnancy. May include proteinuria (protein in 

the urine) without seizures or coma and pathologic edema (generalized swelling, including swelling of the 

hands, legs and face). 

Hypertension (eclampsia): Pregnancy induced hypertension with proteinuria with generalized 

seizures or coma. May include pathologic edema. 
Item 41, page 3 

4/2004; Updated 3/18/2005 

Previous preterm births: History of pregnancy(ies) terminating in a live birth of less than 37 

completed weeks of gestation. 

Other previous poor pregnancy outcome: (Includes perinatal death, small for gestational 

age/intrauterine growth restricted birth) History of pregnancies continuing into the 20th week of gestation 

(post menstrual age) and resulting in any of the listed outcomes. Perinatal death includes fetal and neonatal 

deaths. 

Pregnancy resulted from infertility treatment - Any assisted reproduction technique used to 

initiate the pregnancy. Includes fertility-enhancing drugs (e.g., Clomid, Pergonal), artificial insemination, 

or intrauterine insemination and assisted reproduction technology (ART) procedures (e.g., IVF, GIFT and 

ZIFT). 

- Fertility-enhancing drugs – Any fertility-enhancing drugs (e.g., Clomid, Pergonal), artificial 

insemination, or intrauterine insemination used to initiate the pregnancy. 

- Assisted reproductive technology - Any assisted reproduction technology (ART)/ technical 

procedures (e.g., IVF, GIFT, ZIFT) used to initiate the pregnancy. 

Previous cesearean delivery: Previous operative delivery in which the fetus is extracted through an 

incision in the maternal abdominal and uterine walls. 

When this item is to be completed, it is critical that the recommended message screens 

appear when appropriate. 

The following message should appear first: 

Check this button if the information needed to complete item “Risk factors in 

this pregnancy” is currently not available, but an effort is being made to 

obtain it. 

 Information not currently available 

EBR developers may wish to use a hot key for responding to the above rather than a 

specific button. For example the instruction could read: 

Press the ______key if the information needed to complete this item is 

currently not available, but an effort is being made to obtain it. 

When this button is checked, the item is skipped and placed in pending status for 

completion at a later time on the final review screen. The final review screen for this item 

will be a replica of the initial entry screen with the addition of a box to check 

“unknown.” 

The following instruction should appear when the item is to be completed: 
Item 41, page 4 

4/2004; Updated 3/18/2005 

Please check all the boxes that apply. If the mother had none of the listed risk 

factors, please check the “None of the above” box. DO NOT LEAVE THE ITEM 

BLANK. 

Risk Factors in this Pregnancy: 

Diabetes 

 Prepregnancy (Diagnosis prior to this pregnancy) 

 Gestational (Diagnosis in this pregnancy) 

Hypertension 

 Prepregnancy (Chronic)

 Gestational (PIH, preeclampsia)

 Eclampsia 

 Previous preterm births (<37 completed weeks gestation) 

 Other previous poor pregnancy outcome (includes: perinatal death, small for 

 gestational age/intrauterine growth restricted birth) 

 Pregnancy resulted from infertility treatment 

If Yes, check all that apply: 

 Fertility-enhancing drugs, artificial insemination or intrauterine insemination 

  Assisted reproductive technology (e.g., in vitro fertilization (IVF), 

 gamete intrafallopian transfer (GIFT)) 

 Mother had a previous cesarean delivery 

If yes, how many________ 

 None of the above 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION 

PDIAB Prepregnancy diabetes Y Yes 

 N No 

 U Unknown 

GDIAB Gestational diabetes Y, N, U 

PHYPE Prepregnancy hypertension Y, N, U 

GHYPE Gestational hypertension Y, N,U 

EHYPE Eclampsia Y, N, U 

PPB Previous preterm births Y, N, U 

PPO Poor pregnancy outcomes Y, N, U 

INFT Infertility treatment Y, N, U 

INFT_DRG Infertility: Fertility Enhancing Drugs Y Yes 
Item 41, page 5 

4/2004; Updated 3/18/2005 

 N No 

 X Not Applicable 

 U Unknown 

INFT_ART Infertility: Asst. Rep. Technology Y, N, X, U 

PCES Previous cesarean Y, N, U 

NPCES Number of previous cesareans 0-10, 99 

NPCES_BYPASS 0, 1 

NOA01 None of the above Y, N, U 

DNA01 Pending flag 0 OFF 

 1 ON 

 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

If no boxes are checked, the following message will appear: 

The item has not been completed. If there are risk factors, check the appropriate 

boxe(s). If there are no risk factors, check “None of the above.” 

If the “Data not available at this time” button is checked, the following message shall 

appear: 

Please obtain the information necessary to complete this item. The item will be on 

the final review screen prior to submission to the state. 

The pending flag shall be set to “ON” and all other variables assigned the “unknown” 

code. 

The final review screen shall be a replica of the initial entry screen. If the “Unknown” 

box is checked on the final review screen, the pending flag is set to “OFF” and the 

record is accepted. 

If the “None of the above” box is checked and at least one other box is checked, assign 

the “no” code to the “none of the above” variable” and continue edits. 

If the “None of the above” box is checked and no other box checked, assign all other 

items the “no” code. 

If the “None of the above” box is blank and at least one other box is checked, assign the 

“no” code to all blank boxes. 

The eclampsia and either prepregnancy or gestational hypertention boxes may be 

checked. However, preepregnancy and gestational hypertension cannot both be 

checked. If both boxes are checked, a message should appear that reads: 
Item 41, page 6 

4/2004; Updated 3/18/2005 

“Both the prepregnancy and gestational hypertension boxes are checked. 

Please review the records and choose the correct response.” 

If the “Pregnancy resulted from infertility treatment” (INFT) box is not checked, 

assign “X”s to both “fertility-enhancing drugs” (INFT_DRG) and “assisted 

reproductive technology” (INFT_ART). 

If the “Pregnancy resulted from infertility treatment” (INFT) box is checked, but 

neither types of treatment, “fertility-enhancing drugs” (INFT_DRG) or “assisted 

reproductive technology” (INFT_ART) is checked, assign “U”s to both INFT_DRG 

and INFT_ART. If only the INFT_DRG box is checked, assign “N” to INFT_ART. 

If only the INFT_ART box is checked, assign “N” to INFT_DRG. 

Both the INFT_DRG and INFT_ART boxes may be checked. If one or both of 

INFT_DRG or INFT_ART are checked, but INFT is not checked, assign “Y” to 

INFT. 

If the “Previous cesarean delivery” box is not checked, a value of 0 will be assigned to 

the variable for the number of previous cesarean deliveries. 

If the “Previous cesarean delivery” box is checked, the following screen will immediately 

appear:

Enter the number of previous cesarean deliveries __________. 

If unknown, enter “99.” 

If “0” or no entry is given from the number of previous cesareans, a message should 

appear asking that a number be entered, or 99 if the number is unknown 

 

The number entered must be between >0 and <11. If the number is greater than 10, but 

not 99, the following message appears: 

The record indicates that the number of previous cesarean deliveries is ________. 

Please check “correct” or enter the correct number. 

 Correct 

Number of previous cesarean deliveries________ 

If the value given is still greater than 10, the NPCES_BYPASS is set to “ON-1. If the 

value is greater than 30, it should be changed to “unknown.” 

PAPER RECORD 

Records filed with this field blank are queried. If no response to query, assign each 
Item 41, page 7 

4/2004; Updated 3/18/2005 

choice the “unknown” code. 

If “unknown” is printed in the box, assign each choice the “unknown” code. 

If the “None of the above” box is checked and at least one other box is checked, assign 

the “None of the above” variable the “no” code and continue edits. 

If the “None of the above” box is checked and no other box checked, assign all other 

items the “no” code. 

If the “None of the above” box is blank and at least one other box is checked, assign the 

“no” code to all blank boxes. 

If both the “Prepregnancy diabetes” and “Gestational diabetes” boxes are checked, query. 

If both the “Prepregnancy hypertension” and “Gestational hypertension” boxes are 

checked, query. 

If the “Pregnancy resulted from infertility treatment” box is checked” but neither 

types of treatment, “fertility-enhancing drugs” or “assisted reproductive 

technology” is checked, query. 

If the “Mother had a previous cesarean delivery” box is checked but the number of 

previous cesareans is not given, query. 

State Edits of data file prior to NCHS transmission. 

Must be valid codes (see below). 

See electronic records section (above) for state processing of electronic records. 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

NAME LENGTH TYPE VALUES 

PDIAB 1 Alpha character string Y, N, U 

GDIAB 1 Alpha character string Y, N, U 

PHYPE 1 Alpha character string Y, N, U 

GHYPE 1 Alpha character string Y, N, U 

EHYPE 1 Alpha character string Y, N, U 

PPB 1 Alpha character string Y, N, U 

PPO 1 Alpha character string Y, N, U 

INFT 1 Alpha character string Y, N, U 
Item 41, page 8 

4/2004; Updated 3/18/2005 

INFT_DRG 1 Alpha character string Y, N, X, U 

INFT_ART 1 Alpha character string Y, N, X, U 

PCES 1 Alpha character string Y, N, U 

NPCES 2 Numeric 00-30,99 

NPCES_BYPASS 1 Numeric 0,1 

 

EDI TRANSMISSION: 

No standards set yet. 
Item 42, page 1 

4/2004; Updated 3/18/2005 

Item Title: INFECTIONS PRESENT AND/OR 

TREATED DURING THIS PREGNANCY 

Item Number: 42 Certificate, 15 Facility worksheet

Description: Selected infections that the mother had or was treated for 

during the course of this pregnancy 

Source of Information: 

 Preferred Source: Mother’s prenatal care record 

Other Sources: Labor and delivery nursing admission triage form, 

Admission history and physical, Delivery record 

INSTRUCTIONS* 

* States that implemented the 2003 revision of the birth certificate and fetal death report prior to 2005 may 

have adopted editing specifications that were consistent with the version of the certificate and report in 

effect through October 2003, that is the version that was initially recommended by the Panel to Evaluate 

the U.S. Standard Certificates and Reports (http://www.cdc.gov/nchs/vital_certs_rev.htm). The standard 

certificates and report have now been officially cleared and promulgated by the U.S. Department of Health 

and Human Services, effective November 2003, and incorporate modest changes in some items, including 

this item. States which revise their certificates and report for 2005 and later years are expected to use these 

specifications (dated 3/2005) that reflect the content of the cleared certificates. 

For item 42, the original version of the birth certificate included a checkbox for “herpes simplex virus 

(HSV).” During the clearance process that checkbox was deleted. The final birth certificate does not 

include this checkbox. 

FOR A PAPER RECORD: 

If the prenatal care record is not available and the information is not available from other 

medical records, write “unknown” in the space. More than one infection may be 

checked. 

INFECTIONS PRESENT AND/OR TREATED DURING THIS PREGNANCY 

 (Check all that apply) 

 Gonorrhea 

 Syphilis 

 Chlamydia 

 Hepatitis B 

 Hepatitis C 

 None of the above 
Item 42, page 2 

4/2004; Updated 3/18/2005 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

The following instruction and definitions should appear in the help function: 

Infections present and/or treated during the pregnancy: 

Infections present at the time of pregnancy diagnosis or confirmed diagnosis during the pregnancy 

 with or without documentation of treatment. Documentation of treatment is adequate if a 

definitive diagnosis is not present in the available record. 

Gonorrhea – a positive test for Neisseria gonorrhoeae

Syphilis (also called lues) B. a positive test for Treponema pallidum. 

Chlamydia - a positive test for Chlamydia trachomatis. 

Hepatitis B (HBV, serum hepatitis) - a positive test for the hepatitis B virus. 

Hepatitis C - (non A, non B hepatitis (HCV). A positive test for the hepatitis C virus. 

When this item is to be completed, it is critical that the recommended message screens 

appear. 

The following message should appear first: 

Check this button if the information needed to complete item “Infections 

present and /or treated during this pregnancy” is currently not available, but 

an effort is being made to obtain it. 

 Information not currently available 

EBR developers may wish to use a hot key for responding to the above rather than a 

specific button. For example the instruction could read: 

Press the ______key if the information needed to complete this item is 

currently not available, but an effort is being made to obtain it. 

When this button is checked, the item is skipped and placed in pending status for 

completion at a later time on the final review screen. The final review screen for this item 

will be a replica of the initial entry screen with the addition of a box to check 

“unknown.” 

The following instruction should appear when the item is to be completed: 

Please check all the boxes that apply. If the mother had none of the listed infections 

please check “None of the above.” DO NOT LEAVE THE ITEM BLANK. 

INFECTIONS PRESENT AND/OR TREATED DURING THIS PREGNANCY 
Item 42, page 3 

4/2004; Updated 3/18/2005 

(Check all that apply)

 Gonorrhea 

 Syphilis 

 Chlamydia 

 Hepatitis B 

 Hepatitis C 

 None of the above 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION 

GON Gonorrhea Y, N, U Y—Yes, N—No, 

 U--Unknown 

SYPH Syphilis Y, N, U 

CHAM Chlamydia Y, N, U 

HEPB Hepatitis B Y, N, U 

HEPC Hepatitis C Y, N, U 

NOA02 None of the above Y, N, U 

DNA02 Pending flag 0 OFF 

1 ON 

 

 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

If the “Data not available at this time” button is checked and no specific infections are 

identified, assign the “unknown” codes to each data element and set the pending flag to 

“ON.” If the pending flag is “ON,” the item will appear on the final review screen. 

If the item is left blank and the keyer tabs to the next item, the following message will 

appear. This item must be completed. The entry screen will appear. 

If the “None of the above” box is checked and at least one other box is checked, assign 

the “None of the above” variable the “no ” code and continue edits. 

If the “None of the above” box is checked and no other box checked, assign all other 

items the “no” code. 

If one or more boxes are checked, all boxes not checked are assigned the “no” code. 

PAPER RECORD 
Item 42, page 4 

4/2004; Updated 3/18/2005 

Records filed with this field blank are queried. If no response to query, code each item to 

the “unknown” code. 

If “unknown” is printed or typed in the box, assign each variable the “unknown” code. 

 

If the “None of the above” box is checked and at least one other box is checked, assign 

the “None of the above” variable the “no” code and continue edits. 

If the “None of the above” box is checked and no other box checked, assign all other 

items the “no” code. 

If one or more boxes are checked, all infections not checked will be assigned the “no” 

code. 

State Edits of data file prior to NCHS transmission. 

Must be valid codes (see below). 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAME LENGTH TYPE VALUES 

 

GON 1 Alpha character string Y,N,U 

SYPH 1 Alpha character string Y,N,U 

CHAM 1 Alpha character string Y,N,U 

HEPB 1 Alpha character string Y,N,U 

HEPC 1 Alpha character string Y,N,U 

EDI TRANSMISSION: 

No standards set yet 
Item 43, page 1 

4/2004; Updated 3/18/2005 

Item Title: OBSTETRIC PROCEDURES 

Item Number: 43 Certificate, 16 Facility worksheet

Description: Selected medical treatments or invasive/manipulative 

procedures performed during this pregnancy specifically 

for management of labor and/or delivery. 

Source of Information: 

 Preferred Source: Prenatal care record 

Other Source: Labor and delivery nursing admission triage form, 

Admission history and physical, Delivery record 

INSTRUCTIONS 

FOR A PAPER RECORD: 

If the medical records are not available at this time, print or type “unknown” in the space 

OBSTETRIC PROCEDURES (check all that apply) 

 Cervical cerclage 

 Tocolysis 

External cephalic version 

 Successful 

 Failed 

 None of the above 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics) 

The definitions below should be available through the help function for obstetric 

procedures: 

• Cervical cerclage: Circumferential banding or suture of the cervix to prevent or treat passive 

 dilation. Includes MacDonald’s suture, Shirodkar procedure, abdominal 

 cerclage via laparotomy. 

• Tocolysis: Administration of any agent with the intent to inhibit pre-term uterine contractions to 

 extend the length of the pregnancy. 

• External cephalic version: Attempted conversion of a fetus from a non-vertex presentation to a 
Item 43, page 2 

4/2004; Updated 3/18/2005 

 vertex presentation by external manipulation. 

Success: Fetus was converted to vertex presentation. 

Failure: Fetus was not converted to vertex presentation. 

When this item is to be completed, it is critical that the recommended message screens 

appear when appropriate. 

The following message should appear first: 

Check this button if the information needed to complete item “Risk factors in 

this pregnancy” is currently not available, but an effort is being made to 

obtain it. 

 Information not currently available 

EBR developers may wish to use a hot key for responding to the above rather than a 

specific button. For example, the instruction could read: 

Press the ______key if the information needed to complete this item is 

currently not available, but an effort is being made to obtain it. 

When this button is checked, the item is skipped and placed in pending status for 

completion at a later time on the final review screen. The final review screen for this item 

will be a replica of the initial entry screen with the addition of a box to check “unknown.” 

The following instruction should appear when the item is to be completed: 

Please check all the procedures that apply. If the mother had none of the listed 

procedures or treatments, please check the “None of the above” box. DO NOT 

LEAVE BLANK. 

OBSTETRIC PROCEDURES (Check all that apply) 

 Cervical cerclage 

 Tocolysis 

External cephalic version 

 Successful 

 Failed 

 None of the above 
Item 43, page 3 

4/2004; Updated 3/18/2005 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

CERV Cervical cerclage Y, N, U Y--Yes 

TOC Tocolysis Y, N, U N--No 

ECVS Successful External cephalic U--Unknown 

 version Y, N, U 

ECVF Failed External cephalic 

 version Y, N, U 

NOA03 None of the above Y, N, U 

DNA03 Pending flag 0 OFF 

 1 ON 

 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

If no boxes are checked, the item entry screen will appear with the following message: 

This item has not been completed. Check the appropriate procedures or check 

“None of the above.

If the “Data not available at this time” box is selected, the following message will 

appear: 

Please obtain the information necessary to complete this item. The item will be on 

the final review screen prior to submission to the state. 

The pending flag will be set to “ON” and all other variables assigned the “unknown” 

code. 

The final review screen for this item will be a replica of the initial entry screen. If the 

“Unknown” box is checked on the final review screen, the pending flag is set to “OFF” 

and the record is accepted. 

 

If the “None of the above” box is checked and at least one other box is checked, assign 

the “no” code to the “None of the above” variable and continue edits. 

If the “None of the above” box is checked and no other boxes are checked, assign all 

other items the “no” code. 

If one or more boxes are checked, all procedures not checked will be assigned the “no” 

code. 
Item 43, page 4 

4/2004; Updated 3/18/2005 

“Successful external cephalic version” and the “Failed external cephalic version” 

procedures cannot both be selected. If both are checked, a message should appear that 

reads: 

Both “Successful external cephalic version” and the “Failed external cephalic 

version” boxes are checked. Please review the records and choose the correct 

response. 

PAPER RECORD 

Records filed with this field blank are queried. If no response to query, assign the 

“unknown” code to each procedure variable. 

If “unknown” is printed in the box, assign each procedure variable the “unknown” code 

If the “None of the above” box is checked and at least one other box is checked, assign 

the “no” code to the “None or the above” variable and continue edits. 

If the “None of the above” box is checked and no other box checked, assign all other 

items the “no” code. 

If one or more boxes are checked, all procedures not checked will be assigned the “no” 

code. 

The “Successful external cephalic version” and the “Failed external cephalic version” 

boxes cannot both be checked. If both are checked, query. 

State Edits of data file prior to NCHS transmission. 

Must be valid codes (see below). 

 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

NAME LENGTH TYPE VALUE 

CERV 1 Alpha character string Y, N, U 

TOC 1 Alpha character string Y, N, U 

ECVS 1 Alpha character string Y, N, U 

ECVF 1 Alpha character string Y, N, U 

 

EDI TRANSMISSION: 

No standards set yet 
Item 44, page 1 

4/2004; Updated 3/18/2005 

Item Title: ONSET OF LABOR

Item Number: 44 Certificate, 17 Facility worksheet

Description: Serious complications experienced by the mother 

associated with labor and delivery 

Source of Information: 

 Preferred Source: Labor and delivery record, Delivery comments 

INSTRUCTIONS 

FOR A PAPER RECORD: 

Check all boxes that apply. 

If unknown, print or type “unknown” in the space. 

ONSET OF LABOR 

(Check all that apply)

 Premature Rupture of the Membranes (prolonged, ≥12 hours) 

 Precipitous labor (<3 hours) 

 Prolonged labor (≥20 hours)

 None of the above 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

The following definitions are to be in the help menu for this item: 

Premature Rupture of the Membranes (prolonged≥12 hours) 

Spontaneous tearing of the amniotic sac, (natural breaking of the “bag of waters”), 12 

hours or more before labor begins. 

Precipitous labor (<3hours)

Labor that progresses rapidly and lasts for less than 3 hours. 

Prolonged labor (≥ 20 hours) 

Labor that progresses slowly and lasts for 20 hours or more. 
Item 44, page 2 

4/2004; Updated 3/18/2005 

The following instruction should appear on the screen with the menu: 

Please check all boxes that apply. If none are indicated, check “None of the above.”

If the data are not available at this time, check “Unknown at this time.” DO NOT 

LEAVE THIS ITEM BLANK. 

 Premature Rupture of the Membranes (prolonged, ≥12 hours) 

 Precipitous labor (<3 hours) 

 Prolonged labor (≥20 hours)

 None of the above 

 Unknown at this time 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINTION

 

PROM Premature rupture Y, N, U Y--Yes, N—No, 

PRIC Precipitous labor Y, N, U U--Unknown 

PROL Prolonged labor Y, N, U 

NOA05 None of the above Y, N, U 

DNA05 Pending flag 0 OFF 

 1 ON 

 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

If no boxes are checked, the following message will appear: 

The item has not been completed. Please check “Unknown at this time” if the data 

are not available. If any of the choices listed in the menu are indicated, check the 

appropriate box(s). Please check the “None of the above” box if none of the listed 

maternal morbidity items are indicated. 

If the “None of the above” box is checked and at least one other box checked, assign the 

“None of above box” variable the “no” code and continue edits. 

If the “None of the above” box is checked and no other boxes checked, assign all other 
Item 44, page 3 

4/2004; Updated 3/18/2005 

items the “no” code. 

If the “None of the above” box is blank and at least one other box is checked, assign the 

“no” code to items not checked. 

Precipitous labor and prolonged labor cannot both be checked. If both are checked, as 

message should appear indicated that only one box can be checked and to choose the 

appropriate response. 

PAPER RECORD 

Records filed with all the items in the menu left blank are queried. If no response to 

query, code each item to the “unknown” code. 

If “unknown” is printed in the box, assign each choice the “unknown” code. 

If the “None of the above” box is checked and at least one other box checked, change the 

“None of above box” response to the “no” code and continue edits. 

If the “None of the above” box is checked and no other boxes checked, assign all other 

items the “no” code. 

If the “None of the above” box is blank and at least one other box is checked, assign the 

“no” code to all blank boxes. 

State Edits of data file prior to NCHS transmission. 

Must be valid codes (see below). 

 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

 

NAME LENGTH TYPE VALUES

 

PROM (Premature rupture) 1 Alpha character string Y, N, U 

PRIC (Precipitous labor) 1 Alpha character string Y, N, U 

PROL (Prolonged labor) 1 Alpha character string Y, N, U 

EDI TRANSMISSION: 

No standards set yet 
Item 45, page 1 

4/2004; Updated 3/18/2005 

Item Title: CHARACTERISTICS OF LABOR AND 

DELIVERY 

Item Number: 45 Certificate; 27 Facility worksheet 

Description: Information about the course of labor and delivery. 

Source of information: 

Preferred Source: Delivery record, Physician progress note, Newborn 

admission history and physical 

 

INSTRUCTIONS

FOR A PAPER RECORD: 

More than one characteristic may be checked. 

If the characteristics of the labor and delivery are not known at this time, print or type 

“unknown” in the space. 

CHARACTERISITCS OF LABOR AND DELIVERY 

(Check all that apply) 

 Induction of labor 

 Augmentation of labor 

 Non-vertex presentation 

 Steroids (glucosteroids) for fetal lung maturation received 

by the mother prior to delivery 

 Antibiotics received by the mother during labor 

 Clinical chorioaminionitis diagnosed during labor 

 or maternal temperature >=38 C(100.4 F) 

 Moderate/heavy meconium staining of the amniotic fluid 

 Fetal intolerance of labor such that one or more of the 

following actions was taken: in-utero resuscitation 

measures, further fetal assessment, or operative delivery 

 Epidural or spinal anesthesia during labor 

 None of the above 

FOR AN ELECTRONIC RECORD: 

EBR developer (Instructions are in Italics) 

The following definitions should appear in the help function: 
Item 45, page 2 

4/2004; Updated 3/18/2005 

Induction of labor : Initiation of uterine contractions by medical and/or surgical means for the 

purpose of delivery before the spontaneous onset of labor. 

 

Augmentation of labor: Stimulation of uterine contractions by drug or manipulative technique with 

the intent to reduce the time to delivery. 

 

Non-vertex presentation: Includes any non-vertex fetal presentation, e.g., breech, shoulder, brow, 

face presentations, and transverse lie in the active phase of labor or at delivery other than vertex. 

 

Steroids (glucosteroids) for fetal lung maturation received by the mother prior to 

delivery: Includes betamethasone, dexamethasone, or hydrocortisone specifically given to accelerate 

fetal lung maturation in anticipation of preterm delivery. Excludes steroid medication given to the mother 

as an anti-inflammatory treatment. 

Antibiotics received by the mother during labor: Includes antibacterial medications given 

systemically (intravenous or intramuscular) to the mother in the interval between the onset of labor and the 

actual delivery (Ampicillin, Penicillin, Clindamycin, Erythromycin, Gentamicin, Cefataxime, Ceftriaxone, 

etc.) 

 

Clinical chorioaminionitis diagnosed during labor or maternal 

temperature >=38 C(100.4 F): A clinical diagnosis of chorioamninonotis during labor made by the 

delivery attendant. Usually includes more than one of the following: fever, uterine tenderness and/or 

irritability, leukocytosis, and fetal tachycardia. Any recorded maternal temperature at or above the febrile 

threshold as stated. 

 

Moderate/heavy meconium staining of the amniotic fluid: Staining of the amniotic fluid 

caused by passage of fetal bowel contents during labor and/or delivery which is more than enough to cause 

a greenish color change of an otherwise thin fluid. 

 

Fetal intolerance of labor such that one or more of the following actions was taken: 

in-utero resuscitation measures, further fetal assessment, or operative delivery: In 

utero resuscitative measure-s such as any of the following: maternal position change, oxygen 

administration to the mother, intravenous fluid administered to the mother, amnioinfusion, support of 

maternal blood pressure, and administration of uterine relaxing agents. Further fetal assessment includes 

any of the following: scalp pH, scalp stimulation, acoustic stimulation. Operative delivery-operative 

intervention to shorten time to delivery of the fetus such as forceps, vacuum, or cesarean delivery. 

Epidural or spinal anesthesia during labor: Administration to the mother of a regional 

anesthetic for control of the pain of labor, i.e., delivery of the agent into a limited space with the 

distribution of the analgesic effect limited to the lower body. 

The following instruction should appear for this item: 

Please check all characteristics that apply. If information on the labor and delivery 

are not available at this time check “unknown at this time.” If none of the 

characteristics of labor and delivery apply to this delivery, check “None of the 

above.” DO NOT LEAVE THIS ITEM BLANK. 

 

 Induction of labor 

 Augmentation of labor 
Item 45, page 3 

4/2004; Updated 3/18/2005 

 Non-vertex presentation 

 Steroids (glucosteroids) for fetal lung maturation 

received by the mother prior to delivery 

 Antibiotics received by the mother during labor 

 Clinical chorioaminionitis diagnosed during labor 

or maternal temperature >=38 degreesC(100.4F) 

 Moderate/heavy meconium staining of the amniotic 

fluid 

 Fetal intolerance of labor such that one or more of 

the following actions was taken: in-utero 

resuscitation measures, further fetal assessment, or 

operative delivery 

 Epidural or spinal anesthesia during labor 

 None of the above 

 Unknown at this time 

VARIABLES: 

NAMES DESCRIPTION VALUES DEFINTIONS 

 

INDL Induction of labor Y, N, U Y—Yes, N--N 

AUGL Augmentation of labor Y, N, U U--Unknown 

NVPR Non-vertex present Y, N, U 

STER Steroids Y, N, U 

ANTB Antibiotics Y, N, U 

CHOR Chorioamnionitis Y, N, U 

MECS Meconium staining Y, N, U 

FINT Fetal intolerance Y, N, U 

ESAN Anesthesia Y, N, U 

NOA04 None of the above Y, N, U 

DNA04 Pending flag 0 Off 

1 On 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the state 

If no boxes are checked, the following message will appear: 

The item has not been completed. Please check “Unknown at this time” if the data 

are not available at this time. If any of the characteristics listed in the menu are 
Item 45, page 4 

4/2004; Updated 3/18/2005 

indicated, check the appropriate box(s). Please check the “None of the above” box if 

none of the listed characteristics of labor and delivery are indicated. 

If the “Unknown at this time” box is checked, all other variables are assigned the 

“unknown” code and the flag is set to “ON.” A message will appear that reads: 

Please obtain the records necessary to complete this item. The item will be on the 

final review screen. 

If the “None of the above” box is checked and at least one other box checked, assign the 

“no” code to the “None of above” variable and continue edits. 

If the “None of the above” box is checked and no other boxes checked, assign all other 

items the “no” code. 

If the “None of the above” box is blank and at least one other box is checked, assign the 

“no” code to all blank boxes. 

PAPER RECORD 

Records filed with this item incomplete will be queried. If no response to query, assign 

each item the “unknown” code. 

If “unknown” is printed in the box, assign each choice the “unknown” code. 

If the “None of the above” box is checked and at least one other box checked, assign the 

“no” code to the “None of above” variable and continue edits. 

If the “None of the above” box is checked and no other boxes checked, assign all other 

items the “no” code. 

If the “None of the above” box is blank and at least one other box is checked, assign the 

“no” code to all blank boxes. 

State Edits of data file prior to NCHS transmission. 

Must be valid codes (see below). 

 
Item 45, page 5 

4/2004; Updated 3/18/2005 

NCHS TRANSMISSION FILE

VARIABLES: 

NAME LENGTH TYPE VALUES

 

INDL (Induction of labor) 1 alpha character string Y, N, U 

AUGL (Augmentation of labor) 1 alpha character string Y, N, U 

NVPR (Non-vertex present) 1 alpha character string Y, N, U 

STER (Steroids) 1 alpha character string Y, N, U 

ANTB (Antibiotics) 1 alpha character string Y, N, U 

CHOR (Chorioamnionitis) 1 alpha character string Y, N, U 

MECS (Meconium staining) 1 alpha character string Y, N, U 

FINT (Fetal intolerance) 1 alpha character string Y, N, U 

ESAN (Anesthesia) 1 alpha character string Y, N, U 

EDI TRANSMISSION: 

No standards set yet 
Item 46, page 1 

4/2004; Updated 3/18/2005 

Item Title: METHOD OF DELIVERY

Item Number: 46 certificate, 28 facility worksheet

Description: The physical process by which the complete delivery of 

the fetus was effected. 

Source of Information: 

Preferred source: Delivery record, Physician delivery summary, 

Recovery room record, newborn admission history 

and physical 

 

INSTRUCTIONS 

FOR A PAPER RECORD: 

A response to each section is required. 

If any of the information for an individual section is not known at this time, print or type 

unknown in the space for the particular section. 

METHOD OF DELIVERY 

A. Was delivery with forceps attempted but unsuccessful? 

 Yes  No 

B. Was delivery with vacuum extraction attempted but unsuccessful? 

  Yes  No 

C. Fetal presentation at birth 

 Cephalic 

 Breech 

 Other 

D. Final route and method of delivery (Check one) 

 Vaginal/Spontaneous 

 Vaginal/Forceps 

 Vaginal/Vacuum 

 Cesarean 
Item 46, page 2 

4/2004; Updated 3/18/2005 

If cesarean, was a trial of labor attempted? 

 Yes 

 No 

FOR AN ELECTRONIC RECORD: 

EBR developer (Instructions are in Italics) 

The definitions below should be available through the help function for the item “method 

of delivery.” 

• Attempted forceps or vacuum: Obstetric forceps, ventouse or vacuum cup was applied to the 

 fetal head in an unsuccessful attempt to effect delivery of the 

head through the vagina. 

• Cephalic presentation: Presenting part of the fetus listed as vertex, occiput anterior (OA), 

 occiput posterior (OP). 

• Breech presentation: Presenting part of the fetus listed as breech, complete breech, frank breech, 

 footling breech. 

• Other presentation: Any other presentation or presenting part not listed above.

• Spontaneous delivery: Delivery of the entire fetus through the vagina by the natural 

 forces of labor with or without manual assistance from the delivery 

 attendant. 

• Forceps delivery: Delivery of the fetal head through the vagina by application of 

obstetrical forceps to the fetal head. 

• Vacuum delivery: Delivery of the fetal head through the vagina by application of

 a vacuum cup or ventouse to the fetal head. 

• Cesarean delivery: Extraction of the fetus, placenta and membranes through an incision in the 

 maternal abdominal and uterine walls.

The following instruction should appear when the item is to be completed: 

Please complete each section by checking the appropriate boxes. If the data are not 

available for completing an individual section, check the “Unknown at this time” 

box. DO NOT LEAVE ANY SECTION BLANK. 

Each section should appear individually. As soon as one box is checked in section A, 

section B should then appear. As soon section B is completed, section C should appear, 

etc.. This is to prevent both “yes” and “no” being checked. 
Item 46, page 3 

4/2004; Updated 3/18/2005 

A. Was delivery with forceps attempted but unsuccessful? 

 Yes  No 

 Unknown at this time 

B. Was delivery with vacuum extraction attempted but unsuccessful? 

  Yes  No 

  Unknown at this time 

C. Fetal presentation at birth (Check one) 

 Cephalic 

 Breech 

 Other 

 Unknown at this time 

D. Final route and method of delivery (Check one) 

Vaginal 

 Vaginal/Spontaneous 

 Vaginal/Forceps 

 Vaginal/Vacuum 

 Cesarean 

 Unknown at this time 

If the Cesarean box is checked the following question appears: 

If cesarean, was a trial of labor attempted? 

 Yes 

 No 

 Unknown at this time 
Item 46, page 4 

4/2004; Updated 3/18/2005 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

ATTF Attempted forceps Y, N, U 

ATTV Attempted vacuum Y, N, U 

DNAA Follow up flag section A 0 Off 

 1 On 

DNAB Follow up flag section B 0 Off 

 1 On 

PRES Fetal presentation 1 Cephalic 

2 Breech 

3 Other 

9 Unknown 

DNAC Follow up flag section C 0 Off 

 1 On 

ROUT Route and method of delivery 1 Spontaneous 

2 Forceps 

3 Vacuum 

4 Cesarean 

9 Unknown 

DNAD Follow up flag section D 0 Off 

1 On 

TLAB Trial of labor attempted Y, N, X, U 

DNAL Follow up flag trial of labor 0 Off 

 1 On 

 Y-----Yes 

 N----No 

 X----Not applicable 

 U----Unknown 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

If any of the “Unknown at this time” boxes are checked, the following message appears: 

Please obtain the information necessary to complete this section. The section will 

appear on the final review screen

If any of the “Unknown at this time” boxes are checked the flag for that section is set to 

“ON” and the variables are assigned “unknown” codes

 

SECTION A: DELIVERY ATTEMPTED WITH FORCEPS 
Item 46, page 5 

4/2004; Updated 3/18/2005 

If the “Unknown at this time” box is not checked for the section, either the “yes” or “no” 

box for the item “Attempted forceps” must be checked. If neither box is checked, the 

following message shall appear. 

Please choose either the “yes” or “no” box for the item “Attempted forceps,” or 

check the “Unknown at this time box for the section.” The entry screen should 

appear. 

SECTION B: DELIVERY ATTEMPTED WITH VACUUM 

If the “Unknown at this time” box is not checked, either the “yes” or “no” box for the 

item “Attempted vacuum” must be checked. If neither box is checked, the following 

message shall appear. 

Please choose either the “yes” or “no” box for the item “Attempted vacuum” The 

entry screen should appear. 

 

SECTION C: FETAL PRESENTATION AT BIRTH 

 

If none of the boxes are checked, the following message shall appear: 

 Please choose one of the choices from the menu. The menu of choices shall appear: 

If more than one box is checked, the following message shall appear: 

More than one choice from the menu was selected. Please review and pick only one 

menu item. The menu list shall appear: 

SECTION D: FINAL ROUTE AND METHOD OF DELIVERY 

If none of the boxes are checked, the following message shall appear: 

 Please choose one of the choices from the menu. The menu of choices shall appear: 

If more than one box is checked, the following message shall appear: 

More than one choice from the menu was selected. Please review and pick only one 

menu item. The menu list shall appear: 

If “Cesarean” is checked, a response to the question on the attempted trial of labor is 

required. If neither the “yes” or “no” box is checked, the following message appears: 

A response to the question concerning a trial of labor was not entered. Please choose 

the appropriate box. 
Item 46, page 6 

4/2004; Updated 3/18/2005 

If the “Cesarean” box is not checked, the “not applicable” code shall be assigned to the 

variable “Attempted trial of labor.” 

If the final route and method chosen is “forceps,” the variable for “Attempted forceps” 

must be assigned the “no” code. 

If the final route and method chosen is “vacuum,” the variable “Attempted vacuum” 

must be assigned the “no” code. 

PAPER RECORD 

Records filed with any of the sections for this item are queried. If no response to query, 

code each item to the “unknown” code. 

The edits listed under electronic records apply after data entry of this item. 

State Edits of data file prior to NCHS transmission. 

Must be valid codes (see below). 

 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

NAME LENGTH TYPE VALUE 

ATTF 1 Alpha character string Y, N, U 

ATTV 1 Alpha character string Y, N, U 

PRES 1 Numeric 1,2,3,9 

ROUT 1 Numeric 1,2,3,4,9 

TLAB 1 Alpha character string Y, N, U, X 

 

EDI TRANSMISSION: 

No standards set yet 
Item 47, page 1 

4/2004; Updated 3/18/2005 

Item Title: MATERNAL MORBIDITY

Item Number: 47 Certificate, 29 Facility worksheet

Description: Serious complications experienced by the mother 

associated with labor and delivery 

Source of Information: 

Preferred Source: Delivery record, Recovery room record, Operative 

note, Physician progress note, Transfer note, 

Intake and output form 

INSTRUCTIONS 

FOR A PAPER RECORD: 

Check all boxes that apply. 

If unknown, print or type “unknown” in the space. 

MATERNAL MORBIDITY (Check all that apply) 

(Complications associated with labor and delivery) 

 Maternal transfusion 

 Third or fourth degree perineal laceration 

 Ruptured uterus 

 Unplanned hysterectomy 

 Admission to intensive care unit 

 Unplanned operating room procedure following delivery 

 None of the above 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

The following definitions are to be in the help menu for this item: 

Maternal transfusion: Includes infusion of whole blood or packed red blood cells within the period 

specified. 

 
Item 47, page 2 

4/2004; Updated 3/18/2005 

Third or fourth degree perineal laceration: 3rd degree laceration extends completely through 

the perineal skin, vaginal mucosa, perineal body and anal sphincter. 4th degree laceration is all of the above 

with extension through the rectal mucosa. 

 

Ruptured Uterus: Tearing of the uterine wall. 

Unplanned hysterectomy: Surgical removal of the uterus that was not planned prior to admission for 

delivery. Includes an anticipated or possible but not definitively planned procedure. 

Admission to intensive care unit: Any admission, planned or unplanned, of the mother to a 

facility/unit designated as providing intensive care. 

 

Unplanned operating room procedure following delivery: Any transfer of the mother back 

to a surgical area for an operative procedure that was not planned prior to the admission for delivery. 

Excludes postpartum tubal ligations. 

 

The following instruction should appear on the screen with the menu: 

Please check all boxes that apply. If none are indicated, check “None of the above.”

If the data are not available at this time, check “Unknown at this time.” DO NOT 

LEAVE THIS ITEM BLANK. 

 

 Maternal transfusion 

 Third or fourth degree perineal laceration 

 Ruptured uterus 

 

 Unplanned hysterectomy 

 Admission to intensive care unit 

 Unplanned operating room procedure following delivery 

 None of the above 

 Unknown at this time 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINTION

 

MTR Maternal transfusion Y, N, U Y--Yes, N—No, 

PLAC Perineal laceration Y, N, U U--Unknown 

RUT Ruptured uterus Y, N, U 

UHYS Unplanned hysterectomy Y, N, U 

AINT Admission to intensive care Y, N, U 

UOPR Unplanned operation Y, N, U 

NOA05 None of the above Y, N, U 
Item 47, page 3 

4/2004; Updated 3/18/2005 

DNA05 Pending flag 0 OFF 

 1 ON 

 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

If no boxes are checked, the following message will appear: 

The item has not been completed. Please check “Unknown at this time” if the data 

are not available. If any of the choices listed in the menu are indicated, check the 

appropriate box(s). Please check the “None of the above” box if none of the listed 

maternal morbidity items are indicated. 

If the “None of the above” box is checked and at least one other box checked, assign the 

“None of above box” variable the “no” code and continue edits. 

If the “None of the above” box is checked and no other boxes checked, assign all other 

items the “no” code. 

If the “None of the above” box is blank and at least one other box is checked, assign the 

“no” code to items not checked. 

PAPER RECORD 

Records filed with all the items in the menu left blank are queried. If no response to 

query, code each item to the “unknown” code. 

If “unknown” is printed in the box, assign each choice the “unknown” code. 

If the “None of the above” box is checked and at least one other box checked, change the 

“None of above box” response to the “no” code and continue edits. 

If the “None of the above” box is checked and no other boxes checked, assign all other 

items the “no” code. 

If the “None of the above” box is blank and at least one other box is checked, assign the 

“no” code to all blank boxes. 

State Edits of data file prior to NCHS transmission. 

Must be valid codes (see below). 

 
Item 47, page 4 

4/2004; Updated 3/18/2005 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

 

NAME LENGTH TYPE VALUES

 

MTR (Maternal transfusion) 1 Alpha character string Y, N, U 

PLAC (Perineal laceration) 1 Alpha character string Y, N, U 

RUT (Ruptured uterus) 1 Alpha character string Y, N, U 

UHYS (Unp. hysterectomy ) 1 Alpha character string Y, N, U 

AINT (Admit to intensive care) 1 Alpha character string Y, N, U 

UOPR (Unp. Operation) 1 Alpha character string Y, N, U 

EDI TRANSMISSION: 

No standards set yet
Item 49, page 1 

4/2004; Updated 3/18/2005 

Item Title: BIRTHWEIGHT

 

Item Number: 49 Certificate, 30 Facility worksheet

 

Description: The weight of the infant at birth. 

Source of Information: 

Preferred Source: Delivery record, Admission assessment 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Wherever possible, weigh and report the infant’s birthweight in grams. Report weight in 

pounds and ounces (lb/oz) only if weight in grams is not available. 

DO NOT convert weight from lb/oz to grams. 

Please specify whether grams or lb/oz are used. 

If the birthweight is not known, print or type “unknown” in the space. 

BIRTHWEIGHT (grams preferred, specify unit) 

________________________ 

 grams  lb/oz 

FOR AN ELECTRONIC RECORD: 

EBR Developer: (Instructions are in italics). 

The birthweight of the child is to be entered in the units in which it is measured 

(preferably grams). Hospital staff should not convert from lbs/oz to grams. 

 

The following instruction should appear when the birthweight item is to be completed.

Please check one box below. 

Note: hospitals which only use one unit to measure birthweight may choose to preset 

their systems to either grams or pounds and ounces. For hospitals which do so, the 

following two check boxes need not appear. 

 Birthweight is measured in grams 

 Birthweight is measured in pounds and ounces 

When the box for grams is checked, the following appears:
Item 49, page 2 

4/2004; Updated 3/18/2005 

Birthweight of infant___________________grams. 

When the pounds and ounces box is checked, the following appears: 

Birthweight of infant ___________lbs. ____________ozs. 

The following instruction should appear in the help menu: 

Unknown Birthweight: If the birthweight of the infant is not known, check the grams box and enter 

9999, or the pounds and ounces box and enter 99, 99. States may elect to use a “hot key” or other symbols 

(e.g., “?”) for unknowns. These will be converted to numeric values of 9999 or 99, 99. 

If unknown values are entered the following message will appear: 

Please obtain the records needed to complete this item. The item will appear on the 

final review screen. 

PROCESSING VARIABLES: 

 

NAME DESCRIPTION VALUES DEFINITION

BWG Infant’s birthweight 0000-9998 Birthweight in grams 

9999 Unknown 

BWP Infant’s birthweight 00-20 Birthweight pounds 

BWO Infant’s birthweight 00-15 Birthweight ounces 

99 Birthweight pounds 

99 Birthweight ounces 

 

BW_BYPASS Bypass flag 0 OFF 

1 Queried data correct, 

but out of range 

2 Queried, failed 

birthweight/gestation 

edit. 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

Birthweights in pounds and ounces are converted to grams and assigned to the BWG 

field for editing and tabulation purposes. (Do not convert unknown (99, 99) values for 

pounds and ounces.) 

The conversion algorithm is: 

BWG= ((BWP*16) + BWO)*28.35 
Item 49, page 3 

4/2004; Updated 3/18/2005 

Round the result as follows: If the result is not a whole number and the fraction is 0.5 or 

greater, round to the next higher whole gram. If the fraction is <0.5, round to the lower 

whole gram. 

The item must have a value of 0000-9999. 

If 9999 is entered the following message appears: 

Please obtain the records to complete this item. The item will appear on the final review 

screen. 

If birthweight is ≤ 227 or ≥ 8165 but not 9999, the following message should appear: 

The birthweight of the infant is _________________grams (or lbs/ou). 

Please check the box or enter a new weight. 

 Weight is correct 

Birthweight is ____________ grams. 

If the “Birthweight correct”box is checked the BW_BYPASS variable is set to ON-1. 

If a new birthweight is entered the edit is rerun. If the edit fails, the BW_BYPASS 

variable is set to ON-1. If the edit passes, the BW_BYPASS variable is set to OFF-0. 

BIRTHWEIGHT/GESTATION CONSISTENCY CHECK

The following edit is done if: the BW_BYPASS flag is 0, the birthweight value is not 

9999, and the C_GESTM (calculated months of gestation, see item “Date Last Normal 

Menses Began) is 4-11: 

If C_GESTM is <5 and plurality is any valid value, BW <1,000 grams 

If C_GESTM is 5 and plurality is any valid value, BW < 2,000 grams 

If C_GESTM is 6 and plurality is any valid value, BW< 3,000 grams 

If C_GESTM is 7 and plurality is any valid value, BW <4,000 grams 

If C_GESTM is equal to or >8 and plurality is value 1, BW ≥ 1,000 grams. 

The following edit is done if: the BW_BYPASS flag is 0, the birthweight value is not 

9999, the C_GESTM is not 4-11 (values 99 or 88), the OWGEST (obstetric estimate of 

gestation in weeks, see item “Obstetric Estimate of Gestation”) is 17-47, and the 

OWGEST_BYPASS is 0: 

If OWGEST is <20 and plurality is any valid value, BW <1,000 grams 

If OWGEST is 20-23 and plurality is any valid value, BW < 2,000 grams 

If OWGEST is 24-27 and plurality is any valid value, BW< 3,000 grams 
Item 49, page 4 

4/2004; Updated 3/18/2005 

If OWGEST is 28-31 and plurality is any valid value, BW <4,000 grams 

IF OWGEST is 32-47 and plurality is value 1, BW ≥ 1,000 grams. 

If these edits fail, an error message appears that reads: 

The record indicates that the infant has a gestation of _______months/weeks and a 

birthweight of _________grams. 

Please check the correct box or enter a new birthweight. 

 Birthweight correct 

Birthweight____________ grams 

If the “Birthweight correct” box is checked, the BW_BYPASS flag is set to ON-2 

If a new birthweight is entered, the edit is rerun. If the edit fails, the BW_BYPASS 

variable is set to ON-2. If the edit passes, the BW_BYPASS variable is set to OFF-0. 

PAPER RECORD 

Records filed with the birthweight blank should be queried. If no response to query, 

assign 9999 to the birthweight grams variable. 

State Edits of data file prior to NCHS transmission 

See above edits for electronic records. 

STATE FILE CONSIDERATIONS 

States may want to keep all the processing variables. 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAME LENGTH TYPE VALUES

BWG 4 Numeric 0000-9999 

BW_BYPASS 1 Numeric 0,1,2

 

EDI TRANSMISSION: 

No standards set yet. 
Item 50, page 1 

4/2004; Updated 3/18/2005 

Item Title: OBSTETRIC ESTIMATION OF 

GESTATION

 

Item Number: 50 Certificate, 31 Facility worksheet

 

Description: The obstetric estimate of the infant’s gestation in 

completed weeks based on the birth attendant’s final 

estimate of gestation which should be determined by all 

perinatal factors and assessments such as ultrasound, but 

not the neonatal exam 

Source of Information: 

Preferred Source: OB Admission history and physical 

INSTRUCTIONS 

FOR A PAPER RECORD: 

Please enter the obstetric estimate of the infant’s gestation. 

If the obstetric estimate of gestation is not known, print or type “unknown” in the space. 

Do not complete this item based on the infant’s date of birth and the mother’s date of 

LMP. 

OBSTETRIC ESTIMATE OF GESTATION: 

___________ (completed weeks) 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics) 

The obstetric estimate of the infant’s gestation is to be entered in completed weeks. 

Obstetric estimate of gestation _________________completed weeks. 

The following instruction should appear in the help menu. 

Unknown Obstetric Estimate of Gestation: If the obstetric estimate of the infant’s 

gestation is not known, enter 99. Do not complete this item based on the infant’s date of birth and the 

mother’s date of LMP.
Item 50, page 2 

4/2004; Updated 3/18/2005 

PROCESSING VARIABLES: 

 

NAME DESCRIPTION VALUES DEFINITION

OWGEST Obstetric estimate of gestation 00-98 Gestation in weeks 

 99 Unknown 

OWGEST_BYPASS Bypass flag 0 OFF 

1 Queried data correct, 

but out of range 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

The item must have a value in the range 00-99. 

If 99 is entered, the following message shall appear: 

Please obtain the records needed to complete this item. The item will appear on the 

final review screen. 

If gestation is <17 or >47 but not 99, the following message should appear: 

The obstetric estimate of the infant’s gestation is _________________weeks.

Please check “Correct” or enter a new gestation. 

 Correct 

Gestation is ____________ weeks. 

If “Correct” is checked the OWGEST_BYPASS variable is set to ON-1. 

If a new gestation is entered the edit is rerun. If the edit fails, the OWGEST_BYPASS 

variable is set to ON-1. If the edit passes, the OWGEST_BYPASS variable is set to OFF0. 

PAPER RECORD 

Records filed with the “Obstetric estimate of gestation” blank should be queried. If no 

response to query, enter 99. 

State Edits of data file prior to NCHS transmission 
Item 50, page 3 

4/2004; Updated 3/18/2005 

See above edits for electronic records. 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAME LENGTH TYPE VALUES

OWGEST 2 Numeric 00-98,99 

OWGEST_BYPASS 1 Numeric 0,1 

 

EDI TRANSMISSION: 

No standards set yet. 
Item 51, page 1 

4/2004; Updated 3/18/2005 

Item Title: APGAR SCORE

 

Item Number: 51 Certificate, 33 Facility worksheet

 

Description: The Apgar Score for the child at 5 and 10 minutes 

Source of Information: 

Preferred Source: Delivery record (infant data) 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Enter the infant’s Apgar score at 5 minutes, and if the score at 5 minutes is less than 6, 

enter the infant’s Apgar score at 10 minutes. 

APGAR SCORE 

Score at 5 minutes: __________ 

If 5 minute score is less than 6, 

Score at 10 minutes:__________ 

 

If the infant’s Apgar score is not known or was not taken at 5 minutes or ten minutes, 

print or type “unknown” in the space. 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in italics) 

The following instruction should appear: 

Enter the infant’s Apgar score taken at 5 minutes

If the infant’s Apgar score is not known or was not taken at 5 minutes, enter 99. 

Apgar score at 5 minutes___________. 

If the score entered is 6 or greater, the variable for the Apgar score at 10 minutes is 

assigned the value “88.” 

If the score entered is less than 6 or 99, a request for the Apgar score at 10 minutes 

appears with the following instruction: 

Enter the infant’s Apgar score taken at 10 minutes. 
Item 51, page 2 

4/2004; Updated 3/18/2005 

If the infant’s Apgar score is not known or was not taken at 10 minutes, enter 99. 

Apgar score at 10 minutes__________. 

PROCESSING VARIABLES: 

 

NAME DESCRIPTION VALUES DEFINITION

APGAR5 Apgar score at 5 minutes 00-10 Apgar score 

 99 Unknown 

APGAR10 Apgar score at 10 minutes 00-10 Apgar score 

 88 Not applicable 

99 Unknown 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

The variable APGAR5 must have a value in the range 00-10, 99. 

The variable APGAR10 must have a value in the range 00-10, 88, 99 

If either variable’s value is greater than 10 but not 88 or 99, the following message 

should appear: 

The infant’s Apgar score is recorded as _________________. 

Please re-enter the infant’s Apgar score_________________. 

If the new Apgar score is greater than 10, assign “99” to the appropriate variable. 

PAPER RECORD 

Records filed with the “Apgar score(s)” blank should be queried. If no response to query, 

enter “99” for each variable. 

State Edits of data file prior to NCHS transmission 

See above edits for electronic records. 
Item 51, page 3 

4/2004; Updated 3/18/2005 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAME LENGTH TYPE VALUES

APGAR5 2 Numeric 00-10, 99 

APGAR10 2 Numeric 00-10, 88, 99

 

EDI TRANSMISSION: 

No standards set yet. 
Item 52,53, page 1 

4/2004; Updated 3/18/2005 

Item Titles: PLURALITY 

IF NOT SINGLE BIRTH – Born First, Second, 

Third, etc. (Specify) 

Item Numbers: 52 certificate; 34 facility worksheet 

 53 certificate; 35 facility worksheet 

 N/A certificate; 36 facility worksheet 

Description: Plurality – The number of fetuses delivered live or dead 

at any time in the pregnancy regardless of gestational age 

or if the fetuses were delivered at different dates in the 

pregnancy. (“Reabsorbed” fetuses, those which are not 

“delivered” (expulsed or extracted from the mother) 

should not be counted.) 

If not single birth, specify born 1st, 2nd, etc. – For 

multiple deliveries, the order this infant was delivered in 

the set. Include all live births and fetal losses. 

If not single birth, specify the number of infants in this 

delivery born alive -- For multiple deliveries, the number 

of infants born alive at any point in the pregnancy. 

Source of Information: 

Preferred Source: Admission history and physical, Delivery record 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Item 52, Plurality. 

Print or type the plurality of this pregnancy e.g., single, twin, triplet, etc. Include all 

products of the pregnancy, that is, all live births and fetal deaths delivered at any point 

during the pregnancy. 

PLURALITY - Single, Twin, Triplet, etc. 

(Specify)_________ 
Item 52,53, page 2 

4/2004; Updated 3/18/2005 

Item 53, Set Order. 

If this is a singleton delivery, leave this item blank. For multiple deliveries, print the 

order that this infant was delivered in the set, e.g., first, second, third, etc. Count all live 

births and fetal deaths delivered at any point in the pregnancy.

IF NOT SINGLE BIRTH – Born First, Second, 

Third, etc. (Specify)________ 

 

FOR AN ELECTRONIC RECORD: 

EBR Developer: (Instructions are in italics)

Plurality 

Enter the number of fetuses delivered (1,2,3,4,5,6,7,8,9, etc.) in the pregnancy. 

(Twins=2, Triplets=3 etc.) 

Include all live births and fetal deaths delivered at any point in the pregnancy regardless 

of gestational age. 

Example: If one infant is born alive and two are born dead enter “3.” 

 

If plurality is unknown enter “99.” 

Plurality (number of fetuses delivered)________ 

If plurality = 99, assign “99” to “Set Order” (SORD) and to “Live born” (LIVEB). 

If plurality = 1, assign the “not applicable” code “88” to variables “Set Order” and 

“Live Born.”

If plurality >1 and not “ 99” the following question is asked: 

Enter the order this infant was delivered in the pregnancy or set (1,2,3,4,5,6,7,8,9, etc.) 

Include all live births and fetal deaths delivered at any point in the pregnancy regardless 

of gestational age. 

If the order is unknown enter “99.” 

Set order of this infant__________ 

If plurality is >1 and not “99” the following question is asked: 

Enter the total number of infants born alive in the delivery______ 

If “Live Born” > 1, an identification number unique to each multiple set born in the 

State for that year is generated. Each live born member of the set (and each fetal death, 

if the fetal death system is integrated with the birth) is assigned the same identification 
Item 52,53, page 3 

4/2004; Updated 3/18/2005 

number. This number is entered for the variable “MATCH. The identification number 

may be the mother’s medical record number, or any other identifying number which 

would be unique to the multiple set for that State. 

Example: (Assuming all born live) 

 Twin set A—1st born #345671 

 2nd born #345671 

Twin set B – 1st born #567897 

 2nd born #567897 

Triplet set A –1st born #789014 

 2nd born #789014 

 3rd born #789014 

When a number is assigned, a new record for each member of the set except the 1st born 

is created. Information common to all set members (e.g., mother’s demographic and 

prenatal care information) is copied for each additional infant. Only information 

potentially unique to the individual set member (e.g., method of delivery, abnormal 

conditions, birthweight) need be entered. ( See “Attachment to the Facility Worksheet 

for the Live Birth Certificate for Multiple Births.”) 

The purpose of generating identification numbers for multiple birth sets is to enhance 

quality control and to allow NCHS to more readily match members of multiple birth sets 

for data analysis. 

The default MATCH number is 000000 (single delivery). 

 

If the fetal death reporting system is integrated with the EBR system, sequence numbers 

can be assigned to fetal deaths delivered in multiple deliveries and fetal death reports 

initiated. 

PROCESSING VARIABLES: 

 

NAME DESCRIPTION VALUES DEFINITION

PLUR Plurality 01-12 Number of fetuses 

 delivered 

 99 Unknown 

SORD Set order 01-12 Order this infant was 

 delivered in the set 

88 Not applicable 

99 Unknown 

LIVEB Number of Live born 01-12 Number of infants 
Item 52,53, page 4 

4/2004; Updated 3/18/2005 

delivered alive 

 88 Not applicable 

99 Unknown 

MATCH Matching number 000001to An ID number 

999999 unique to multiple 

birth sets. Each set 

member has the same 

ID number. 

PLUR_BYPASS edit flag 0 OFF 

1 ON, queried and 

correct 

2 ON, Plurality/Set 

Order queried and 

inconsistent 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

Plurality must be in the range 1-12, 99. 

If plurality is >9 but not 99, the following message should appear: 

The number of fetuses in this delivery is recorded as_________________. 

Please indicate whether this number is “correct” or enter a new number. 

 correct 

Number of fetuses (born live or dead) in this delivery____________ 

If “Correct” is checked the PLUR_BYPASS variable is set to ON-1. 

If a new number is entered the edit is rerun. If the edit fails, the PLUR_BYPASS variable 

is set to ON-1. If the edit passes, the PLUR_BYPASS variable is set to OFF-0. 

If plurality >12 after the edit is run, change the value to 12. 

If plurality = “99,” “set order” must = “99.” 

If plurality = “1,” “set order” must = “88.” 

If plurality >1 but not “99,” “set order” must be ≤ plurality. 
Item 52,53, page 5 

4/2004; Updated 3/18/2005 

 If this edit fails the following message occurs: 

The record indicates that there were ______fetuses in this delivery but the set order of the 

infant was_________. 

Please enter a new value for each of these items: 

Total number of fetuses (born live and dead) in this delivery____________ 

Set order of this infant _________ 

The edit is re-run and if it fails the bypass flag is set to ON-2. 

The number of infants born alive in this delivery must be ≤ the plurality. If it is not, a 

message should appear showing the discrepancy and asking that it be resolved by 

reentering “plurality” and “set order.” 

For quality control, the EBR system should make sure that the correct number of records 

is completed for each live born infant in the multiple delivery by comparing the number 

for which the same identification number (MATCH) has been generated with the number 

reported as “Live born“ (LIVEB). 

PAPER RECORD 

Records filed with the “Plurality” item blank are to be queried. If no response to query, 

assign “99” to the “plurality” and “set order” variables. 

If “plurality” is > 1 and the “set order” is blank, query. If no response to query, assign 

“99” to the set order variable. 

STATE DATA FILE CONSIDERATIONS 

If states key literals for plurality (single, twin, etc.) and first, second etc for “Set order”, 

on paper records, they will have to be translated to the corresponding numerical value for 

editing and transmission to NCHS. 

NCHS TRANSMISSION FILE 

Values of “88” for the SORD and LIVEB variables are changed to “99” for transmission 

to NCHS. 

Any values greater than “12” other than “99” for the PLUR and ORDER variables are 

assigned the value “12” for transmission to NCHS 

VARIABLES: 
Item 52,53, page 6 

4/2004; Updated 3/18/2005 

NAME LENGTH TYPE VALUES

PLUR 2 Numeric 01-12, 99 

SORD 2 Numeric 01-12, 99 

LIVEB 2 Numeric 01-12, 99 

MATCH 6 Numeric 000001- 

 999999 

PLUR_BYPASS 1 Numeric 0,1,2 

 

EDI TRANSMISSION: 

No standards set yet. 
Item 54, page 1 

4/2004; Updated 3/18/2005 

Item Title: ABNORMAL CONDITIONS OF THE 

NEWBORN

 

Item Number: 54 Certificate; 37 Facility worksheet

Description: Disorders or significant morbidity experienced by the 

newborn infant 

Source of Information: 

Preferred Source: Labor and delivery summary, Newborn history and 

physical, Newborn medical admission record 

INSTRUCTIONS 

FOR A PAPER RECORD: 

Check all boxes that apply to this child. 

ABNORMAL CONDITIONS OF THE NEWBORN 

 

 Assisted ventilation required immediately after delivery 

 Assisted ventilation required for more than 6 hours 

 NICU admission 

 Newborn given surfactant replacement therapy 

 Antibiotics received by the newborn for suspected neonatal sepsis 

 Seizure or serious neurologic dysfunction 

 Significant birth injury (skeletal fracture(s), peripheral nerve injury, 

and/ or soft tissue/solid organ hemorrhage which requires intervention) 

 None of the above 

 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

The following definitions are to be in the help menu for this item: 

Assisted ventilation required immediately after delivery: Infant given manual breaths with 

bag and mask or bag and endotracheal tube within the first several minutes from birth for any duration. 

Excludes oxygen only and laryngoscopy for aspiration of meconium. 

 

Assisted ventilation required for more than 6 hours: Infant given mechanical ventilation 

(breathing assistance) by any method for more than 6 hours. Includes conventional, high frequency and/or 

continuous positive pressure (CPAP). 
Item 54, page 2 

4/2004; Updated 3/18/2005 

 

NICU admission: Admission into a facility or unit staffed and equipped to provide continuous 

mechanical ventilatory support for the newborn. 

Newborn given surfactant replacement therapy: Endotracheal instillation of a surface active 

suspension for the treatment of surfactant deficiency either due to preterm birth or pulmonary injury 

resulting in decreased lung compliance (respiratory distress). Includes both artificial and extracted natural 

surfactant. 

Antibiotics received by the newborn for suspected neonatal sepsis: Any antibacterial drug 

given systemically (intravenous or intramuscular.)(e.g. penicillin, ampicillin, gentamicin, cefotoxine, etc.)

 

Seizure or serious neurologic dysfunction: Seizure defined as any involuntary repetitive, 

convulsive movement or behavior. Serious neurologic dysfunction defined as severe alteration of alertness 

such as obtundation, stupor, or coma, i.e. hypoxicischemic encephalopathy. Excludes lethargy or hypotonia 

in the absence of other neurologic findings. Exclude symptoms associated with CNS congenital anomalies. 

Significant birth injury: (skeletal fracture(s), peripheral nerve injury and/or soft tissue/solid organ 

hemorrhage which requires intervention) Defined as present immediately following delivery or manifesting 

following delivery. Includes any bony fracture or weakness or loss of sensation, but excludes fractured 

clavicles and transient facial nerve palsy. Soft tissue hemorrhage requiring evaluation and/or treatment 

includes sub-galeal (progressive extravasation within the scalp) hemorrhage, giant cephalohematoma, 

extensive truncal, facial and /or extremity ecchymossi accompanied by evidence of anemia and/or 

hypovolemia and or hypotension. Solid organ hemorrhage includes subcapsular hematoma of the liver, 

fractures of the spleen, or adrenal hematoma. All require confirmation by diagnostic imaging or exploratory 

laparotomy. See below for listing of significant birth injuries: 

Skeletal Fractures 

 Clavicle 

 Humerus 

Skull (Also reported by skull bone, i.e. parietal, frontal, occipital) 

 Femur 

Peripheral Nerve 

 Facial 

 Brachial Plexus Injury 

 (Also reported as Erb’s Palsy, Klumpke’s Palsy) 

 Phrenic 

 Recurrent Laryngeal 

Soft Tissue or Solid Organ Hemorrhage 

 Cranial (exclude cephalohemtoma, hemorrhagic caput succedaneum) 

 Subgaleal 

 Cortical 

 Intraventricular 

 Subcapsular hematoma of liver 

 Adrenal hemorrhage/hematoma

 
Item 54, page 3 

4/2004; Updated 3/18/2005 

The following instruction should appear with the menu. 

Please check all boxes that apply. If none of the abnormal conditions of the newborn 

are indicated, check “None of the above.” DO NOT LEAVE THIS ITEM BLANK. 

 

 Assisted ventilation required immediately after delivery 

 Assisted ventilation required for more than 6 hours 

 NICU admission 

 Newborn given surfactant replacement therapy 

 Antibiotics received by the newborn for suspected neonatal sepsis 

 Seizure or serious neurologic dysfunction 

 Significant birth injury (skeletal fracture(s), peripheral nerve injury, 

and/or soft tissue/solid organ hemorrhage which requires intervention) 

 None of the above 

 Unknown at this time 

 

PROCESSING VARIABLES: 

NAMES DESCRIPTION VALUES DEFINTION 

 

AVEN1 Assisted ventilation Y, N, U Y--Yes, N—No, 

AVEN6 Assisted ventilation for 6 or 

more hours Y, N, U U--Unknown 

NICU Admission to NICU Y, N, U 

SURF Surfactant replacement 

therapy Y, N, U 

ANTI Antibiotics Y, N, U 

SEIZ Seizure or serious neurologic 

dysfunction Y, N, U 

BINJ Significant birth injury Y, N, U 

NOA54 None of the above Y, N, U 

DNA54 Pending flag 0 OFF 

 1 ON 

EDITS: 
Item 54, page 4 

4/2004; Updated 3/18/2005 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

If no boxes are checked, the following message will appear: 

The item has not been completed. If the data are not available at this time please 

check “Unknown at this time.” If any of the abnormal conditions listed in the menu 

are indicated, check the appropriate box. Check “None of the above” if none of the 

listed abnormal conditions are indicated. 

If the unknown at this time box is checked all variables are assigned the “unknown” code 

and the pending flag is set to “ON.” A message will appear that reads: 

Please obtain the records needed to complete this item. The item will appear on the final 

review screen. 

If the “None of the above” box is checked and at least one other box checked, assign the 

“None of above” variable the “no” code and continue edits. 

If the “None of the above” box is checked and no other boxes checked, assign all other 

items the “no” code. 

If the “None of the above” box is blank and at least one other box is checked, assign the 

“no” code to items not checked. 

PAPER RECORD 

Records filed with all the items in the menu left blank are queried. If no response to 

query, assign each item to the “Unknown” code. 

If “unknown” is printed in the box, assign each choice in the menu the “unknown” code. 

If the “None of the above” box is checked and at least one other box checked, change the 

“None of above” response to the “no” code and continue edits. 

If the “None of the above” box is checked and no other boxes checked, assign all items 

the “no” code. 

If the “None of the above” box is blank and at least one other box is checked, assign the 

“no” code to all blank boxes. 

State Edits of data file prior to NCHS transmission. 

Must be valid codes (see below). 

 
Item 54, page 5 

4/2004; Updated 3/18/2005 

NCHS TRANSMISSION FILE 

 

 

VARIABLES: 

NAME LENGTH TYPE VALUES

 

AVEN1 (Assisted ventilation) 1 Alpha character string Y, N, U 

AVEN6 (Assisted ventilation 6) 1 Alpha character string Y, N, U 

NICU (Admission to NICU) 1 Alpha character string Y, N, U 

SURF (Surfactant) 1 Alpha character string Y, N, U 

ANTI (Antibiotics) 1 Alpha character string Y, N, U 

SEIZ (Seizures) 1 Alpha character string Y, N, U 

BINJ (Birth injury) 1 Alpha character string Y, N, U 

EDI TRANSMISSION: 

No standards set yet 
Item 55, page 1 

4/2004; Updated 3/18/2005 

Item Title: CONGENITAL ANOMALIES OF THE 

NEWBORN

Item Number: 55 Certificate, 38 Facility worksheet

Description: Malformations of the newborn diagnosed prenatally or 

after delivery 

Source of Information: 

Preferred Source: Labor and delivery summary, Infant history and 

physical, Physician progress notes, Newborn 

admission history and physical

INSTRUCTIONS 

FOR A PAPER RECORD: 

CONGENITAL ANOMALIES OF THE NEWBORN 

Check all boxes that apply to this child. For “Downs Syndrome” and Suspected 

Chromosomal disorder” if karyotype status is unknown leave both the “Karyotype 

confirmed” and “Karyotype pending” boxes blank. 

 Anencephaly 

 Meningomyelocele / Spina Bifida 

 Cyanotic congenital heart disease 

 Congenital diaphramatic hernia 

 Omphalocele 

 Gastroschisis 

 Limb reduction defect (excluding congenital amputation and dwarfing 

syndromes) 

 Cleft Lip with or without Cleft Palate 

 Cleft Palate alone 

 Down Syndrome 

 Karyotype confirmed 

 Karyotype pending 

 Suspected chromosomal disorder 

 Karyotype confirmed 

 Karyotype pending 

 Hypospadias 

 None of the anomalies listed above 
Item 55, page 2 

4/2004; Updated 3/18/2005 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics)

The following definitions are to be in the help menu for this item: 

Anencephaly: Partial or complete absence of the brain and skull. Also called anencephalus, acrania, or 

absent brain. Babies with craniorachischisis (anencephaly with contiguous spine defect) should also be 

included in this category. 

 

Meningomyelocele / Spina Bifida: Spina bifida refers to herniation of the meninges and/or spinal 

cord tissue through a bony defect of spine closure. Meningomyelocele refers to herniation of meninges and 

spinal cord tissue. Babies with meningocele (herniation of meninges without spinal cord tissue) should also 

be included in the category. Both open and closed (covered with skin) lesions should be included. Spina 

bifida occulta (a midline bony spinal defect without protrusion of the spinal cord or meninges) should not 

be included in this category. 

 

Cyanotic congenital heart disease: Congenital heart defects which cause cyanosis. Includes but is 

not limited to transposition of the great arteries (vessels), teratology of Fallot, pulmonary or pulmonic 

valvular atresia, tricuspid atresia, truncus arteriosus, total/partial anomalous pulmonary venous return with 

or without obstruction. 

Congenital diaphragmatic hernia: Defect in the formation of the diaphragm allowing herniation 

of abdominal organs into the thoracic cavity. 

Omphalocele: A defect in the anterior abdominal wall, accompanied by herniation of some abdominal 

organs through a widened umbilical ring into the umbilical stalk. The defect is covered by a membrane, 

(different from gastroschisis, see below), although this sac may rupture. Also called exomphalos. Umbilical 

hernia (completely covered by skin) should not be included in this category. 

 

Gastroschisis: An abnormality of the anterior abdominal wall, lateral to the umbilicus, resulting in 

herniation of the abdominal contents directly into the amniotic cavity. Differentiated from omphalocele by 

the location of the defect and absence of a protective membrane. 

Limb reduction defect: (excluding congenital amputation and dwarfing syndromes) Complete or 

partial absence of a portion of an extremity secondary to failure to develop. 

Cleft Lip with or without Cleft Palate: Cleft lip with or without cleft palate refers to incomplete 

closure of the lip. Cleft lip may be unilateral, bilateral or median; all should be included in this category. 

Cleft Palate alone: Cleft palate refers to incomplete fusion of the palatal shelves. This may be limited 

to the soft palate or may also extend into the hard palate. Cleft palate in the presence of cleft lip should be 

included in the “Cleft Lip with or without cleft Palate” category, rather than here. 

Down Syndrome: Trisomy 21 

Suspected chromosomal disorder: Includes any constellation of congenital malformations 

resulting from or compatible with known syndromes caused by detectable defects in chromosome structure. 
Item 55, page 3 

4/2004; Updated 3/18/2005 

Hypospadias: Incomplete closure of the male urethra resulting in the urethral meatus opening on the 

ventral surface of the penis. Includes first degree – on the glans ventral to the tip, second degree – in the 

coronal sulcus, and third degree – on the penile shaft. 

The following menu of congenital anomalies of the newborn should be used. The 

following instruction should appear on the screen with the menu. 

Please check all boxes that apply. If the information needed to complete this item is 

not available at this time please check the “Unknown at this time” box. If none of 

the congenital anomalies of the newborn are indicated, check the “None of the 

above” box. DO NOT LEAVE THIS ITEM BLANK. 

CONGENITAL ANOMALIES OF THE NEWBORN 

Check all boxes that apply: 

 Anencephaly 

 Meningomyelocele / Spina Bifida 

 Cyanotic congenital heart disease 

 Congenital diaphramatic hernia 

 Omphalocele 

 Gastroschisis 

 Limb reduction defect (excluding congenital amputation and dwarfing 

syndrones) 

 Cleft Lip with or without Cleft Palate 

 Cleft Palate alone 

 Down Syndrome 

 Karyotype confirmed 

 Karyotype pending 

 Suspected chromosomal disorder 

 Karyotype confirmed 

 Karyotype pending 

 Hypospadias 

 None of the anomalies listed above 

 Unknown at this time 

Systems should be designed so that “Karyotype pending” or “Karyotype confirmed” can 

only be selected if “Down Syndrome” and/or “Suspected chromosomal disorder 

anomalies” are checked. 

 

The following instruction should appear with the “Karyotype confirmed“ / “Karyotype 

pending” item: 

If karyotype status is unknown, leave both “Karyotype confirmed” and “Karyotype 
Item 55, page 4 

4/2004; Updated 3/18/2005 

pending” boxes blank. 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINTION

 

ANEN Anencephaly Y, N, U Y--Yes, N—No, 

MNSB Meningomyelocele/ 

Spina Bifida Y, N, U U--Unknown 

CCHD Cyanotic congenital 

heart disease Y, N, U 

CDH Congenital diaphragmatic 

hernia Y, N, U 

OMPH Omphalocele Y, N, U 

GAST Gastroschisis Y, N, U 

LIMB Limb reduction defect Y, N, U 

CL Cleft Lip with or without 

 Cleft Palate Y, N, U 

CP Cleft Palate alone Y, N, U 

DOWN Down Syndrome Y, N, U 

DOWC Down Karyotype 

 confirmed Y, N, U 

DOWP Down Karyotype 

 pending Y, N, U 

CDIS Suspected chromosomal 

 disorder Y, N, U 

CDIC Suspected chromosomal 

 disorder karyotype 

 confirmed Y, N, U 

CDIP Suspected chromosomal 

 disorder karyotype 

 pending Y, N, U 

HYPO Hypospadias Y, N, U 

 

NOA55 None of the above Y, N, U 

DNA55 Follow up flag 0 OFF 

 1 ON 
Item 55, page 5 

4/2004; Updated 3/18/2005 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

If no boxes are checked, the following message will appear: 

The item has not been completed. Please check the “Unknown at this time” box if 

the data are not available to complete this item at this time. Check the “None of the 

above” box if none of the listed anomalies are indicated. If any of the anomalies 

listed in the menu are indicated, check the appropriate box(s). 

If the “Unknown at this time” box is checked, all variables are assigned the “unknown” 

code and the pending flag is set to “ON.” A message will appear that reads: 

Please obtain the records needed to complete this item. The item will appear on the 

final review screen. 

If the “None of the above” box is checked and at least one other box checked, assign the 

“no” code to the “None of above” variable” and continue edits. 

If the “None of the above” box is checked and no other boxes checked, assign all other 

items the “no” code. 

If the “None of the above” box is blank and at least one other box is checked, assign the 

“no” code to all blank boxes. 

If the “Down syndrome” and/or “Suspected chromosomal disorder” boxes are checked, 

but it is unknown whether the karyotype is “confirmed” or “pending,” leave both the 

“confirmed” and “pending” boxes blank. Processing variables DOWC AND DOWP, 

CDIC and CDIP are assigned the value “U.” 

PAPER RECORD 

Records filed with all the items in the menu left blank are queried. If no response to 

query, code each item to the “unknown” code. 

If the “None of the above” box is checked and at least one other box checked, change the 

“None of above box” response to the “no” code and continue edits. 

If the “None of the above” box is checked and no other boxes checked, assign all other 

items the “no” code. 
Item 55, page 6 

4/2004; Updated 3/18/2005 

If the “None of the above” box is blank and at least one other box is checked, assign the 

“no” code to all blank boxes. 

If the “Down Syndrome” box is checked and no boxes for the “Karyotype confirmed or 

pending” are checked, assign the unknown or “U” response to “karyotype pending” and 

the “U” response to “karyotype confirmed.” If both boxes are checked, assign the “Y” 

response to “karyotype confirmed” and the “N” response to “karyotype” pending. 

If the “Suspected chromosomal disorder” box is checked and no boxes for the 

“Karyotype confirmed or pending” are checked, assign the unknown or “U” response to 

“karyotype pending” and the “U” response to “karyotype confirmed.” If both boxes are 

checked, assign the “Y” response to “karyotype confirmed” and “N” response to the 

“karyotype pending.” 

If a “karyotype confirmed or pending” box is checked and the corresponding anomaly is 

not checked, query. If no response to query assign all variables the “U” code. 

State Edits of data file prior to NCHS transmission. 

Must be valid codes (see below). 

The processing variables DOWN, DOWC, and DOWP are combined into one variable 

“DOWT” for transmission as follows: 

If the processing variable DOWN is assigned the “Y” code and DOWC is assigned the 

“Y” code, assign DOWT the value “C.” 

 If the processing variable DOWN is assigned the “Y” code and DWOP is assigned the 

“Y” code, assign DOWT the value “P.” 

If the processing variable DOWN is assigned the “Y” code and both processing variables 

DOWC and DOWP are assigned the “U” code, assign DOWT the value “P.” 

If the processing variable DOWN is assigned the “N” code, assign DOWT the value “N” 

If the processing variable DOWN is assigned the “U” code, assign DOWT the value “U.” 

The processing variables CDIS, CDIC, and CDIP are combined into one variable called 

CDIT for transmission as follows: 

If the processing variable CDIS is assigned the “Y” code and CDIC is assigned the “Y” 

code, assign CDIT the value “C.” 

If the processing variable CDIS is assigned the “Y” code and CDIP is assigned the “Y” 

code, assign CDIT the value “P.” 

If the processing variable CDIS is assigned the “Y” code and both processing variables 

CDIC and CDIP are assigned the “U” code, assign CDIT the value “P.” 

 

If the processing variable CDIS is assigned the “N” code, assign CDIT the value “N” 

If the processing variable CDIS is assigned the “U” code, assign CDIT the value “U.” 
Item 55, page 7 

4/2004; Updated 3/18/2005 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

NAME LENGTH TYPE VALUES 

 

ANEN (Anencephaly) 1 Alpha character string Y, N, U 

MNSB (Meningomyelocele/Spina Bifida) 1 Alpha character string Y, N, U 

CCHD (Cyanotic congenital heart disease) 1 Alpha character string Y, N, U 

CDH (Congenital diaphragmatic hernia) 1 Alpha character string Y, N, U 

OMPH (Omphalocele) 1 Alpha character string Y, N,U 

GAST (Gastroschisis) 1 Alpha character string Y, N,U 

LIMB (Limb reduction defect) 1 Alpha character string Y, N, U 

CL (Cleft Lip with or without Cleft Palate) 1 Alpha character string Y, N, U 

CP (Cleft Palate alone) 1 Alpha character string Y, N, U 

DOWT (Down Syndrome) 1 Alpha character string C, P, N, U 

CDIT ( Suspected chromosomal disorder) 1 Alpha character string C, P, N, U 

HYPO (Hypospadias) 1 Alpha character string Y, N, U 

EDI TRANSMISSION: 

No standards set yet 
Item 56, page 1 

4/2004; Updated 3/18/2005 

Item Title: WAS INFANT TRANSFERRED WITHIN 24 

HOURS OF DELIVERY? 

 

Item Number: 56 Certificate, 39 facility worksheet

 

Description: Information on the transfer status of the infant within 24 

hours after delivery 

Source of Information: 

Preferred source: Infant progress notes, Transfer form 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Check “yes” if the infant was transferred from this facility to another within 24 hours of 

delivery and enter the name of the facility the infant was transferred to. 

If the name of the facility is not known, print or type “unknown.” 

If the infant was transferred more than once, enter the name of the first facility to which 

the infant was transferred. 

WAS INFANT TRANSFERRED WITHIN 24 HOURS OF DELIVERY?  Yes  No 

IF YES, PRINT OR TYPE THE NAME OF THE FACILITY THE INFANT WAS 

TRANSFERRED TO:________________________________________________ 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics) 

Was the infant transferred to a different facility within 24hours of delivery? 

 Yes 

 No 

 Unknown 

If the yes box is checked, the following appears: 

Please enter the name of the facility to which the infant was transferred. 
Item 56, page 2 

4/2004; Updated 3/18/2005 

If the name of the facility is not known, enter “unknown.” 

If the infant was transferred more than once enter the name of the first facility to which 

the infant was transferred. 

Facility name:_____________________________ 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

ITRAN Infant transferred Y Yes 

 N No 

 U Unknown 

FTRAN Name of facility to which 

 transferred Alpha character string 

EDITS: 

ELECTRONIC RECORD 

The transfer status cannot be blank. 

If transfer status is left blank, the item will reappear at the final review screen. 

If transfer status is “no”, the name of facility field must be blank. 

If the transfer status is “yes”, the name of facility field must have an entry. “Unknown” 

is an acceptable entry. 

If the name of the facility field has any entry except “unknown” and the transfer status is 

“no,” a query message should appear asking that the inconsistency be corrected. 

PAPER RECORD 

Records filed with the transfer status blank shall be queried. If no response to query, enter 

response of “unknown.” 

If transfer status is “no,” the name of facility field must be blank. 

If the transfer status is “yes,” the name of facility field must have an entry. “Unknown” is 

an acceptable entry. 

If the name of the facility field has any entry except “unknown” and the transfer status is 

“no,” query the inconsistency and resolve. 
Item 56, page 3 

4/2004; Updated 3/18/2005 

State Edits of data file prior to NCHS transmission 

Must be a valid code (see below) 

STATE FILE CONSIDERATIONS 

States will need to have a field for the literal entry of facility names and/or NPI numbers 

or state facility codes. 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

NAME LENGTH TYPE VALUES

ITRAN 1 Alpha character string Y, N, U 

 

 

EDI TRANSMISSION: 

 

No standards set yet 
Item 57, page 1 

4/2004; Updated 3/18/2005 

Item Title: IS INFANT LIVING AT THE TIME OF 

REPORT?

 

Item Number: 57 Certificate, 40 facility worksheet

 

Description: Information on the infant’s survival. 

Source of Information: 

Preferred Source: Infant progress notes 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Check “Yes” if the infant is living. 

Check “Yes” if the infant has already been discharged to home care. 

Check “No” if it is known that the infant has died. 

If the infant was transferred but the status is known, indicate the known status. 

IS INFANT LIVING AT TIME OF REPORT? 

 Yes  No  Infant transferred, status unknown 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics) 

The following instructions should appear when this item is to be completed: 

Check “Yes” if the infant is living. 

Check “Yes” if the infant has already been discharged to home care. 

Check “No” if it is known that the infant has died. 

If the infant was transferred but the status is known, please indicate the known status. 

Is the infant living at the time of this report? 

 Yes 

 No 

 Infant transferred, status unknown 

If the “No” box is checked states may want to consider a pop-up window that appears 

which reminds the facility that a death record must also be completed by the infant’s 

physician. 
Item 57, page 2 

4/2004; Updated 3/18/2005 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

ILIV Infant living Y Yes 

 N No 

 U Infant transferred, 

status unknown 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

The living status cannot be blank. 

PAPER RECORD 

Records filed with the item “Is infant living at the time of report” blank shall be queried. 

If no response to query, enter response of “yes.” 

State Edits of data file prior to NCHS transmission 

Must be a valid code (see below) 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

NAME LENGTH TYPE VALUES

ILIV 1 Alpha character string Y, N, U 

 

 

EDI TRANSMISSION: 

 

No standards set yet. 
Item 58, page 1 

4/2004; Updated 3/18/2005 

Item Title: IS INFANT BEING BREASTFED AT 

DISCHARGE? 

Item Number: 58 Certificate; 41 facility work sheet

 

Description: Information on whether the infant is being breastfed at 

discharge from the hospital. 

Source of Information: 

Preferred Source: Labor and delivery summary, Maternal progress note, 

Newborn flow record, Lactation consult 

INSTRUCTIONS* 

* States that implemented the 2003 revision of the birth certificate and fetal death report prior to 2005 may 

have adopted editing specifications that were consistent with the version of the certificate and report in 

effect through October 2003, that is the version that was initially recommended by the Panel to Evaluate 

the U.S. Standard Certificates and Reports (http://www.cdc.gov/nchs/vital_certs_rev.htm). The standard 

certificates and report have now been officially cleared and promulgated by the U.S. Department of Health 

and Human Services, effective November 2003, and incorporate modest changes in some items, including 

this item. States which revise their certificates and report for 2005 and later years are expected to use these 

specifications (dated 3/2005) that reflect the content of the cleared certificates. 

For item 58, the original version of the birth certificate read “Is infant being breast fed?” During the 

clearance process the item was reworded as follows: “Is the infant being breastfed at discharge?” 

FOR A PAPER RECORD: 

 

Check “Yes” if the infant is being breastfed at discharge. 

Check “No” if the infant is not being breastfed at discharge. 

If it is not known if the infant is being breastfed at discharge, print or type “unknown” in 

the space. 

IS INFANT BEING BREASTFED AT DISCHARGE?  Yes  No 

FOR AN ELECTRONIC RECORD: 

EBR Developer (Instructions are in Italics) 

Is the infant being breastfed at discharge? 

 Yes 

 No 

 Unknown at this time 
Item 58, page 2 

4/2004; Updated 3/18/2005 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

BFED Infant breastfed at discharge Y Yes 

 N No 

 U Unknown 

 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State

If the “Unknown at this time” box is checked assign the unknown code and the following 

message should appear. 

Please obtain the records needed to complete this item. The item will appear on the 

final review screen. 

The item cannot be blank. 

PAPER RECORD 

Records filed with the item “Is infant being breastfed at discharge?” blank shall be 

queried. If no response to query, enter response of “unknown.” 

State Edits of data file prior to NCHS transmission 

Must be a valid code (see below) 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

NAMES LENGTH TYPE VALUE

BFED 1 Alpha character string Y, N, U 

 

EDI TRANSMISSION: 

 

No standards set yet.
File Processing Items 

Page 1 

 

4/2004; Updated 3/18/2005 

File Processing Item: State of birth 

File Layout Location: 5-6 

Description: Information about the State of occurrence of the birth. 

 

Source of Information:

Preferred Source: System generated or State vital statistics staff

INSTRUCTIONS 

FOR A PAPER RECORD: 

State vital statistics staff

Use the 2- character alpha State code from Appendix B to be superseded by NCHS Part 

8A (from FIPS table 5-2). 

FOR AN ELECTRONIC RECORD: 

Use the 2- character alpha State code from Appendix B to be superseded by NCHS Part 

8A (from FIPS table 5-2). 

EDR Developer 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

BSTATE State of birth Alpha Appendix B 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAMES LENGTH TYPE VALUES

BSTATE 2 Alpha character string Appendix B 
File Processing Items 

Page 2 

 

4/2004; Updated 3/18/2005 

File Processing Item: Certificate number (State file number) 

File Layout Location: 7-12 

Description: Information about the record used for quality control, 

management, and evaluation. 

 

Source of Information:

Preferred Source: System generated or State vital statistics staff

INSTRUCTIONS 

FOR A PAPER RECORD: 

State vital statistics staff

To be used for administrative and management purposes. Left fill with zeros if the State 

file number has fewer than 6 digits. 

FOR AN ELECTRONIC RECORD: 

EDR Developer 

To be used for administrative and management purposes. Left fill with zeros if the 

State file number has fewer than 6 digits. 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

FILENO State file number 6-digit Left fill zero if not 6 

 digits 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAMES LENGTH TYPE VALUES

FILENO 6 Numeric character string 000001-999999 

File Processing Item: Void flag 
File Processing Items 

Page 3 

 

4/2004; Updated 3/18/2005 

File Layout Location: 13-13

Description: Information about the record used for quality control, 

management, and evaluation. 

 

Source of Information:

Preferred Source: System generated or State vital statistics staff

INSTRUCTIONS 

FOR A PAPER RECORD: 

State vital statistics staff

To help identify records that have been voided from the data file. 

FOR AN ELECTRONIC RECORD: 

EDR Developer 

To help identify records that have been voided from the data file. 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

VOID Flag indicating void 0 Valid record 

(default) 

1 Void record 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAMES LENGTH TYPE VALUES

VOID 1 Numeric character string 0,1 

File Processing Item: Auxiliary state file number 
File Processing Items 

Page 4 

 

4/2004; Updated 3/18/2005 

File Layout Location: 14-25

Description: Information about the record used for quality control, 

management, and evaluation. 

 

Source of Information:

Preferred Source: System generated or State vital statistics staff

INSTRUCTIONS 

FOR A PAPER RECORD: 

State vital statistics staff

To be used for administrative and management purposes. Left fill with zeros if the 

auxiliary State file number has fewer than 12 digits. 

FOR AN ELECTRONIC RECORD: 

EDR Developer 

To be used for administrative and management purposes. Left fill with zeros if the 

auxiliary State file number has fewer than 12 digits. 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

AUXNO Auxiliary State file number 12-digit Left fill zero if not 12 

 digits, blank 
File Processing Items 

Page 5 

 

4/2004; Updated 3/18/2005 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAMES LENGTH TYPE VALUES

AUXNO 12 Numeric character string 000000000001-999999999999, 

 blank 
 

4/2004; Updated 3/18/2005 

Appendix A 

TABLE OF COUNTRY CODES
Appendix A 

 Page 1 

4/2004; Updated 3/18/2005 

APPENDIX A 

COUNTRY CODES 

Codes marked with an “*” indicate historic political entities that no longer exist. Some of the 

historic political entities appear multiple times in the list: alphabetically and indented following 

the related active political entities. When active and historic political entities have the same 

name, dates have been provided to help select the most appropriate code. A few codes appear 

more than once in the list alphabetized under commonly use variants of the official name. Italics 

are used to indicate all codes appearing more than once, whether because of a name variation or 

because a historic code has been grouped with the current active country. 

NOTE: Codes are not available for countries that ceased to exist prior to June 15, 1970. To 

code an event for a country for which a code is not available, use the code for the closest 

contemporary country (i.e. a code that is not italicized). 

AFGHANISTAN AF 

ALBANIA AL 

ALGERIA AG 

AMERICAN SAMOA AQ 

ANDORRA AN 

ANGOLA AO 

ANGUILLA AV 

ANTARCTICA AY 

ANTIGUA AND BARBUDA AC 

ARGENTINA AR 

ARMENIA [as of September 21, 1991] AM 

UNION OF SOVIET SOCIALIST 

REPUBLICS [November 7, 1917 to 

December 26, 1991] 

UR *

ARUBA [as of January 1, 1986] AA 

NETHERLANDS ANTILLES [prior to 

January 1, 1986] 

NA *

ASHMORE AND CARTIER ISLANDS AT 

AUSTRALIA AS 

AUSTRIA AU 

AZERBAIJAN [as of August 30, 1991] AJ 

UNION OF SOVIET SOCIALIST 

REPUBLICS [November 7, 1917 to 

December 26, 1991] 

UR *

BAHAMAS, THE BF 

BAHRAIN BA 

BANGLADESH BG 

BARBADOS BB 

BASSAS DA INDIA BS 

BELARUS [as of August 25, 1991] BO 

UNION OF SOVIET SOCIALIST 

REPUBLICS [November 7, 1917 to 

December 26, 1991] 

UR *

BELGIUM BE 

BELIZE BH 

BENIN BN 

DAHOMEY [BENIN] DM *

BERMUDA BD 

BHUTAN BT 

BOLIVIA BL 

BOSNIA AND HERZEGOVINA [as of April 5, 

1992] 

BK 

YUGOSLAVIA [December 1, 1918 to 

April 11, 1992] 

YO *

BOTSWANA BC 

BOUVET ISLAND BV 

BRAZIL BR 

BRITISH INDIAN OCEAN TERRITORY IO 

BRITISH VIRGIN ISLANDS VI 

BRUNEI BX 

BULGARIA BU 
Appendix A 

 Page 2 

4/2004; Updated 3/18/2005 

BURKINA FASO UV 

BURMA BM 

BURUNDI BY 

CAMBODIA CB 

CAMEROON CM 

CANADA CA 

CANTON AND ENDERBERRY ISLANDS EQ *

CAPE VERDE CV 

CAYMAN ISLANDS CJ 

CENTRAL AFRICAN REPUBLIC CT 

CENTRAL AND SOUTHERN LINE ISLANDS CL *

CHAD CD 

CHILE CI 

CHINA CH 

CHRISTMAS ISLAND KT 

CLIPPERTON ISLAND IP 

COCOS (KEELING) ISLANDS CK 

COLOMBIA CO 

COMOROS CN 

CONGO (DEMOCRATIC REPUBLIC OF THE 

CONGO) 

CG 

CONGO (REPUBLIC OF THE CONGO) CF 

COOK ISLANDS CW 

CORAL SEA ISLANDS CR 

COSTA RICA CS 

COTE D' IVOIRE IV 

CROATIA [as of June 11, 1992] HR 

YUGOSLAVIA [December 1, 1918 to 

April 11, 1992] 

YO *

CUBA CU 

CYPRUS CY 

CZECH REPUBLIC [as of January 1, 1993] EZ 

CZECHOSLOVAKIA [October 28, 1918 to 

January 1, 1993] 

CZ *

DAHOMEY [BENIN] DM *

DENMARK DA 

DJIBOUTI DJ 

DOMINICA DO 

DOMINICAN REPUBLIC DR 

EAST BERLIN [prior to October 3, 1990] EB *

EAST GERMANY (GERMAN DEMOCRATIC 

REPUBLIC) [October 11, 1949 to October 3, 

1990] 

GC *

EAST TIMOR [as of October 1999] TT 

TIMOR [prior to 1975] PT *

ECUADOR EC 

EGYPT EG 

EL SALVADOR ES 

ENGLAND (UNITED KINGDOM) UK

EQUATORIAL GUINEA EK 

ERITREA ER 

ESTONIA [as of August 20, 1991] EN 

UNION OF SOVIET SOCIALIST 

REPUBLICS [November 7, 1917 to 

December 26, 1991] 

UR *

ETHIOPIA ET 

EUROPA ISLAND EU 

FALKLAND ISLANDS FK 

FAROE ISLANDS FO 

FIJI FJ 

FINLAND FI 

FRANCE FR 

FRENCH GUIANA FG 

FRENCH POLYNESIA FP 

FRENCH SOUTHERN AND ANTARCTIC 

LANDS 

FS 

FRENCH TERRITORY OF THE AFFARS AND 

ISSAS 

FT *

GABON GB 

GAMBIA, THE GA 

GAZA STRIP GZ 

GEORGIA [as of April 9, 1991] GG 

UNION OF SOVIET SOCIALIST 

REPUBLICS [November 7, 1917 to 

December 26, 1991] 

UR *

GERMANY [as of October 3, 1990] GM 

EAST BERLIN [October 11, 1949 to October 3, 

1990] 

EB *

EAST GERMANY (GERMAN 

DEMOCRATIC REPUBLIC) [October 

11, 1949 to October 3, 1990] 

GC *

WEST BERLIN [September 21, 1949 to 

October 3, 1990] 

WB *

WEST GERMANY (FEDERAL 

REPUBLIC OF GERMANY) [September 

21, 1949 to October 3, 1990] 

GE *
Appendix A 

 Page 3 

4/2004; Updated 3/18/2005 

GHANA GH 

GIBRALTAR GI 

GILBERT ISLANDS GS *

GILBERT AND ELLICE ISLANDS GN *

GLORIOSO ISLANDS GO 

GREAT BRITIAN (UNITED KINGDOM) UK

GREECE GR 

GREENLAND GL 

GRENADA GJ 

GUADELOUPE GP 

GUAM GQ 

GUATEMALA GT 

GUERNSEY GK 

GUINEA GV 

GUINEA-BISSAU PU 

GUYANA GY 

HAITI HA 

HEARD ISLAND AND MCDONALD ISLANDS HM 

HOLY SEE (VATICAN CITY) VT 

HONDURAS HO 

HONG KONG HK 

HOWLAND ISLAND HQ 

HUNGARY HU 

ICELAND IC 

INDIA IN 

SIKKIM [prior to 1975] SK *

INDONESIA ID 

IRAN IR 

IRAQ IZ 

IRAQ-SAUDI ARABIA NEUTRAL ZONE IY *

IRELAND EI 

ISLE OF MAN IM 

ISRAEL IS 

ISRAEL-JORDAN DEMILITARIZED ZONE IW *

ISRAEL-SYRIA DEMILITARIZED ZONE IU *

ITALY IT 

IVORY COAST, THE (COTE D' IVOIRE) IV

JAMAICA JM 

JAN MAYEN JN 

SVALBARD AND JAN MAYEN JS *

JAPAN JA 

JARVIS ISLAND DQ 

JERSEY JE 

JOHNSTON ISLAND JQ 

JORDAN JO 

JUAN DE NOVA ISLAND JU 

KAZAKHSTAN [as of December 16, 1991] KZ 

UNION OF SOVIET SOCIALIST 

REPUBLICS [November 7, 1917 to 

December 26, 1991] 

UR *

KENYA KE 

KIRIBATI KR 

KUWAIT KU 

KYRGYZSTAN [as of August 31, 1991] KG 

UNION OF SOVIET SOCIALIST 

REPUBLICS [November 7, 1917 to 

December 26, 1991] 

UR *

LAOS LA 

LATVIA [August 21, 1991] LG 

UNION OF SOVIET SOCIALIST 

REPUBLICS [November 7, 1917 to 

December 26, 1991] 

UR *

LEBANON LE 

LESOTHO LT 

LIBERIA LI 

LIBYA LY 

LIECHTENSTEIN LS 

LITHUANIA [as of March 11, 1990] LH 

UNION OF SOVIET SOCIALIST 

REPUBLICS [November 7, 1917 to 

December 26, 1991] 

UR *

LUXEMBOURG LU 

MACAU MC 

MACEDONIA, F.Y.R.O. [as of September 17, 

1991] 

MK 

YUGOSLAVIA [December 1, 1918 to 

April 11, 1992] 

YO *

MADAGASCAR MA 

MALAWI MI 

MALAYSIA MY 

MALDIVES MV 

MALI ML 

MALTA MT 
Appendix A 

 Page 4 

4/2004; Updated 3/18/2005 

MARSHALL ISLANDS RM 

MARTINIQUE MB 

MAURITANIA MR 

MAURITIUS MP 

MAYOTTE MF 

MEXICO MX 

MICRONESIA, FEDERATED STATES OF FM 

MIDWAY ISLAND MQ 

MOLDOVA [as of August 27, 1991] MD 

UNION OF SOVIET SOCIALIST 

REPUBLICS [November 7, 1917 to 

December 26, 1991] 

UR *

MONACO MN 

MONGOLIA MG 

MONTSERRAT MH 

MOROCCO MO 

SPANISH NORTH AFRICA ME *

SPANISH SAHARA SS *

MOZAMBIQUE MZ 

NAMIBIA WA 

NAURU NR 

NEPAL NP 

NETHERLANDS NL 

NETHERLANDS ANTILLES [as of January 1, 

1986] 

NT 

NETHERLANDS ANTILLES [prior to January 1, 

1986] 

NA *

NEW CALEDONIA NC 

NEW ZEALAND NZ 

NICARAGUA NU 

NIGER NG 

NIGERIA NI 

NIUE NE 

NORFOLK ISLAND NF 

NORTH KOREA KN 

NORTH VIETNAM [October 26, 1955 to July 2, 

1976] 

VN *

NORTHERN MARIANAS ISLANDS CQ 

NORWAY NO 

OMAN MU 

PAKISTAN PK 

PALAU PS 

PALMYRA ATOLL LQ 

PANAMA [as of October 1, 1979] PM 

PANAMA [November 6, 1903 to October 1, 1979] PN *

PANAMA CANAL ZONE [November 6, 1903 to 

October 1, 1979] 

PQ *

PAPUA NEW GUINEA PP 

PARACEL ISLANDS PF 

PARAGUAY PA 

PERU PE 

PHILIPPINES RP 

PITCAIRN ISLAND PC 

POLAND PL 

PORTUGAL PO 

PUERTO RICO RQ 

QATAR QA 

REUNION RE 

ROMANIA RO 

RUSSIA [August 24, 1991] RS 

UNION OF SOVIET SOCIALIST 

REPUBLICS [November 7, 1917 to 

December 26, 1991] 

UR *

RWANDA RW 

RYUKYU ISLANDS, SOUTHERN YQ *

SAINT HELENA SH 

SAINT KITTS AND NEVIS SC 

SAINT LUCIA ST 

SAINT PIERRE AND MIQUELON SB 

SAINT VINCENT AND THE GRENADINES VC 

SAMOA WS 

SAN MARINO SM 

SAO TOME AND PRINCIPE TP 

SAUDI ARABIA SA 

SENEGAL SG 

SEYCHELLES SE 

SIERRA LEONE SL 

SIKKIM [prior to 1975] SK *

SINGAPORE SN 

SLOVAKIA [as of January 1, 1993] LO 

CZECHOSLOVAKIA [October 28, 1918 

to January 1, 1993] 

CZ *
Appendix A 

 Page 5 

4/2004; Updated 3/18/2005 

SLOVENIA [as of June 25, 1991] SI 

YUGOSLAVIA [December 1, 1918 to 

April 11, 1992] 

YO *

SOLOMON ISLANDS BP 

SOMALIA SO 

SOUTH AFRICA SF 

SOUTH GEORGIA AND THE SOUTH 

SANDWICH ISLANDS 

SX 

SOUTH KOREA KS 

SOUTH VIETNAM [October 26, 1955 to July 2, 

1976] 

VS *

SOUTHERN RHODESIA [prior to April 18, 1980] RH *

SOVIET UNION (UNION OF SOVIET SOCIALIST 

REPUBLICS) [November 7, 1917 to December 26, 

1991] 

UR *

SPAIN SP 

SPANISH NORTH AFRICA ME *

SPANISH SAHARA SS *

SPRATLY ISLANDS PG 

SRI LANKA CE 

SUDAN SU 

SURINAME NS 

SVALBARD SV 

SVALBARD AND JAN MAYEN JS *

SWAN ISLANDS SQ *

SWAZILAND WZ 

SWEDEN SW 

SWITZERLAND SZ 

SYRIA SY 

TAIWAN TW 

TAJIKISTAN [as of September 9, 1991] TI 

UNION OF SOVIET SOCIALIST 

REPUBLICS [November 7, 1917 to 

December 26, 1991] 

UR *

TANZANIA TZ 

THAILAND TH 

TIMOR [prior to 1975] PT *

TOGO TO 

TOKELAU TL 

TONGA TN 

TRINIDAD AND TOBAGO TD 

TROMELIN ISLAND TE 

TRUST TERRITORY OF THE PACIFIC 

ISLANDS 

TQ *

TUNISIA TS 

TURKEY TU 

TURKMENISTAN [as of October 27, 1991] TX 

UNION OF SOVIET SOCIALIST 

REPUBLICS [November 7, 1917 to 

December 26, 1991] 

UR *

TURKS AND CAICOS ISLANDS TK 

TUVALU TV 

UGANDA UG 

UKRAINE [as of August 24, 1991] UP 

UNION OF SOVIET SOCIALIST REPUBLICS 

[November 7, 1917 to December 26, 1991] 

UR *

UNITED ARAB EMIRATES [as of December 1, 

1998] 

AE 

UNITED ARAB EMIRATES [prior to December 

1, 1998] 

TC *

UNITED KINGDOM UK 

UNITED STATES US 

UNITED STATES VIRGIN ISLANDS VQ 

URUGUAY UY 

US MISCELLANEOUS PACIFIC ISLANDS IQ *

UZBEKISTAN [September 1, 1991] UZ 

UNION OF SOVIET SOCIALIST 

REPUBLICS [November 7, 1917 to 

December 26, 1991] 

UR *

VANUATU NH 

VATICAN CITY (HOLY SEE) VT

VENEZUELA VE 

VIETNAM [as of July 2, 1976] VM 

NORTH VIETNAM [October 26, 1955 to 

July 2, 1976] 

VN *

SOUTH VIETNAM [October 26, 1955 to 

July 2, 1976] 

VS *

WAKE ISLAND WQ 

WALLIS AND FUTUNA WF 

WEST BANK WE 

WEST BERLIN [September 21, 1949 to October 

3, 1990] 

WB *

WEST GERMANY (FEDERAL REPUBLIC OF 

GERMANY) [September 21, 1949 to October 3, 

1990] 

GE *

WESTERN SAHARA WI 

YEMEN [as of May 22, 1990] YM 

YEMEN (ADEN) [prior to May 22, 1990] YS *
Appendix A 

 Page 6 

4/2004; Updated 3/18/2005 

YEMEN (SANA'A) [prior to May 22, 1990] YE *

YUGOSLAVIA [as of April 11, 1992] YI 

YUGOSLAVIA [December 1, 1918 to April 11, 

1992] 

YO *

ZAMBIA ZA 

ZIMBABWE ZI 

SOUTHERN RHODESIA [prior to April 

18, 1980] 

RH *

 

NOT CLASSIFIABLE ZZ 
4/2004; Updated 3/18/2005 

Appendix B 

TABLE OF STATE, TERRITORY, AND 

CANADIAN PROVINCE CODES
Appendix B 

Page 1 

4/2004; Updated 3/18/2005 

APPENDIX B 

STATE, TERRITORY, AND CANADIAN PROVINCE CODES 

U.S. State and Territory coding information included in this appendix will be incorporated into the 

revised NCHS geographic coding manual (Instruction Manual Part 8). Release of the revised manual, 

in electronic format, is expected in August 2002. 

VALID VALUES

 U.S. States 

Alabama AL 

Alaska AK 

Arizona AZ 

Arkansas AR 

California CA 

Colorado CO 

Connecticut CT 

Delaware DE 

District of Columbia DC 

Florida FL 

Georgia GA 

Hawaii HI 

Idaho ID 

Illinois IL 

Indiana IN 

Iowa IA 

Kansas KS 

Kentucky KY 

Louisiana LA 

Maine ME 

Maryland MD 

Massachusetts MA 

Michigan MI 

Minnesota MN 

Mississippi MS 

Missouri MO 

Montana MT 

Nebraska NE 

Nevada NV 

New Hampshire NH 

New Jersey NJ 

New Mexico NM 

New York NY 

New York City YC (note: not a standard FIPS code) 

North Carolina NC 

North Dakota ND 

Ohio OH 

Oklahoma OK 

Oregon OR 

Pennsylvania PA 
Appendix B 

Page 2 

4/2004; Updated 3/18/2005 

Rhode Island RI 

South Carolina SC 

South Dakota SD 

Tennessee TN 

Texas TX 

Utah UT 

Vermont VT 

Virginia VA 

Washington WA 

West Virginia WV

Wisconsin WI 

Wyoming WY 

U.S. Territories 

American Samoa AS 

Federated States of Micronesia FM 

Marshall Islands MH 

Northern Marianas MP 

Palau PW 

Puerto Rico PR 

Virgin Islands VI 

Guam GU 

Source: FIPS 5-2 [http://www.itl.nist.gov/fipspubs/] 

Canadian Provinces (for use with residence item only) 

Alberta AB 

British Columbia BC 

Manitoba MB 

New Brunswick NB 

Newfoundland NF 

Northwest Territories NT 

Nova Scotia NS 

Nunavut NU 

Ontario ON 

Prince Edward Island PE 

Quebec QC 

Saskatchewan SK 

Yukon Territory YT 

Source: Canadian Postal Codes 

Unknown or blank ZZ 
4/2004; Updated 3/18/2005 

Appendix C 

TABLE OF CITY AND COUNTY 

CODES
Appendix C 

Page 1 

4/2004; Updated 3/18/2005 

APPENDIX C 

CITY & COUNTY CODES 

City and County coding information included in this appendix has been incorporated into 

the revised NCHS geographic coding manual (Instruction Manual Part 8). The URLs for 

the manuals are: 

Part 8-Geographic Classification, 2003 is available at 

http://www.cdc.gov/nchs/data/dvs/IMP8_PrintVersion.pdf

Part 8a-Geographic Classification (FIPS), 2004 is available at 

http://www.cdc.gov/nchs/data/dvs/IMP8A_PrintVersion.pdf

CITY CODES 

 VALID VALUE

 See FIPS 55-3 name table 

 Not classifiable 99999 

Source: FIPS 55-3 [http://www.itl.nist.gov/fipspubs/] 

COUNTY 

 VALID VALUE

 See FIPS 6-4 name table 

 Not classifiable 999 

Source: FIPS 6-4 [http://www.itl.nist.gov/fipspubs/] 
 

4/2004; Updated 3/18/2005 

Appendix D 

HISPANIC ORIGIN CODE 

LOOK-UP TABLE 

Available on the Revision Website 

http://www.cdc.gov/nchs/vital_certs_rev.htm

Code List – Hispanic Code Titles 

(Acrobat file and Excel table) 
 

4/2004; Updated 3/18/2005 

Appendix E 

TABLE OF RACE CODES 

Available on the Revision Website 

http://www.cdc.gov/nchs/vital_certs_rev.htm

Code List – Race Code Titles 

(Acrobat file and Excel table)