5/2004; Updated 2/18/2005 

Fetal Death Edit Specifications for the 2003 Revision of 

the U.S. Standard Report of Fetal Death 

Note: This document replaces Instruction Manual Part 3b, 

“Classification and Coding Instructions for Fetal Death Records” 
5/2004; Updated 2/18/2005 

Table of Contents 

U.S. Standard Report of Fetal Death 

 

 GENERAL GUIDELINES 

OVERVIEW

FINAL REVIEW SCREEN

SUMMARY LETTER ON GUIDELINES FOR ELECTRONIC 

 SYSTEMS

Item 1 NAME OF FETUS* 

Item 2 TIME OF DELIVERY

Item 3 SEX

Item 4 DATE OF DELIVERY

Items 5-9 CITY, TOWN OR LOCATION OF DELIVERY; ZIP CODE OF DELIVERY;

COUNTY OF DELIVERY; PLACE WHERE DELIVERY OCCURRED;

FACILITY NAME; FACILITY ID

Item 10a MOTHER’S CURRENT LEGAL NAME* 

Item 10b DATE OF BIRTH (mother/patient) 

Item 10c MOTHER’S NAME PRIOR TO FIRST MARRIAGE* 

Item 10d BIRTHPLACE (state, territory, or foreign country) 

Item 11a-g RESIDENCE OF MOTHER/PATIENT: STATE; COUNTY; CITY, TOWN OR 

LOCATION; STREET AND NUMBER; APT. NO.; ZIP CODE; INSIDE CITY 

LIMITS? 

Item 12a FATHER’S CURRENT LEGAL NAME* 

Item 12b DATE OF BIRTH (father) 

Item 12c BIRTHPLACE (father)* 

Item 13 METHOD OF DISPOSITION 

Item 14 ATTENDANT’S NAME, TITLE, AND NPI 

Item 15 NAME AND TITLE OF PERSON COMPLETING REPORT* 

Item 16 DATE REPORT COMPLETED* 

Item 17 DATE RECEIVED BY REGISTRAR* 

Item 18a INITIATING CAUSE/CONDITION

Item 18b OTHER SIGNIFICANT CAUSES OR CONDITIONS

Item 18c WEIGHT OF FETUS

Item 18d OBSTETRIC ESTIMATION OF GESTATION AT DELIVERY

Item 18e ESTIMATED TIME OF FETAL DEATH

Item 18f WAS AN AUTOPSY PERFORMED

Item 18g WAS A HISTOLOGICAL PLACENTAL EXAMINATION PERFORMED

Item 18h WERE AUTOPSY OR HISTOLOGICAL PLACENTAL EXAMINATION 

RESULTS USED IN DETERMINING THE CAUSE OF FETAL DEATH

Item 19 MOTHER/PATIENT’S EDUCATION

Item 20 MOTHER/PATIENT OF HISPANIC ORIGIN? 

Item 21 MOTHER/PATIENT’S RACE

Item 22 MOTHER/PATIENT MARRIED? 

Item 23a-b DATES OF FIRST AND LAST PRENATAL CARE VISIT

Item 24 TOTAL NUMBER OF PRENATAL CARE VISITS FOR THIS PREGNANCY
5/2004; Updated 2/18/2005 

Item 25 MOTHER/PATIENT’S HEIGHT

Item 26 MOTHER/PATIENT’S PREPREGNANCY WEIGHT

Item 27 MOTHER/PATIENT’S WEIGHT AT DELIVERY

Item 28 DID MOTHER/PATIENT GET WIC FOOD FOR HERSELF DURING THIS 

PREGNANCY? 

Items 29a-c, 30a-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 31 CIGARETTE SMOKING BEFORE AND DURING PREGNANCY

Item 32 DATE LAST NORMAL MENSES BEGAN

Items 33, 34 PLURALITY; IF NOT SINGLE BIRTH- BORN FIRST, SECOND, THIRD, ETC. 

(specify) 

Item 35 MOTHER/PATIENT TRANSFERRED FOR MATERNAL MEDICAL OR 

FETAL INDICATIONS FOR DELIVERY? 

Item 36 RISK FACTORS IN THIS PREGNANCY

Item 37 INFECTIONS PRESENT AND/OR TREATED DURING THIS PREGNANCY

Item 38 METHOD OF DELIVERY

Item 39 MATERNAL MORBIDITY

Item 40 CONGENITAL ANOMALIES OF THE FETUS

* Item is not part of the NCHS data set. 
5/2004; Updated 2/18/2005 

File Processing Items State of Delivery 

 Report 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 
GENERAL GUIDELINES, page 1 

5/2004; Updated 2/18/2005 

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. 
GENERAL GUIDELINES, page 2 

5/2004; Updated 2/18/2005 

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 

• 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 
GENERAL GUIDELINES, page 3 

5/2004; Updated 2/18/2005 

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 

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. 
GENERAL GUIDELINES, page 4 

5/2004; Updated 2/18/2005 

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 numeric 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 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 
GENERAL GUIDELINES, page 5 

5/2004; Updated 2/18/2005 

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. 

• 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 
GENERAL GUIDELINES, page 6 

5/2004; Updated 2/18/2005 

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 

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, 
GENERAL GUIDELINES, page 7 

5/2004; Updated 2/18/2005 

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.) 

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.) 
GENERAL GUIDELINES, page 8 

5/2004; Updated 2/18/2005 

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 9 

5/2004; Updated 2/18/2005 

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 

delivery except the patient’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 10 

5/2004; Updated 2/18/2005 

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 11 

5/2004; Updated 2/18/2005 

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 23(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 patient received prenatal care. 

 Yes, the patient received prenatal care 

 No, the patient 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 12 

5/2004; Updated 2/18/2005 

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 24 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. 
GENERAL GUIDELINES, page 13 

5/2004; Updated 2/18/2005 

 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 
GENERAL GUIDELINES, page 14 

5/2004; Updated 2/18/2005 

entries which must be corrected before the record can be filed. 

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 welldesigned 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 and 

the EDR, and “The Guide to Completing the Facility Worksheet” for the EBR 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 Ano 

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. 
GENERAL GUIDELINES, page 15 

5/2004; Updated 2/18/2005 

Page 3 - Colleague 

! For items where it is only correct to chose 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 
GENERAL GUIDELINES, page 16 

5/2004; Updated 2/18/2005 

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 1, page 1 

5/2004; Updated 2/18/2005 

Item Title: NAME OF FETUS (Optional-at the discretion of 

the parents) (Item is not part of the NCHS data set.)

Item Number: 1 Report, 1 Patient’s Worksheet 

Description: The name of the fetus as provided by the parents. 

Source of Information:

Preferred Source: Patient 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Print or type the First, Middle, and Last Names of the fetus including suffix. If the 

parents choose not to name the fetus, leave the item blank In some states the report or 

certificate of fetal death requires that the fetus be named. In these cases state law or rule 

should be followed in regards to the name of the fetus.

 

If the fetus is named, it is suggested that you print or type the names as provided to you 

by the parents and have the parents check the spelling and order of names before entering 

the name on the report. 

If there appears to be more than one spelling of any name provided, and the correct 

spelling cannot be verified, use the most common spelling. 

If the fetus is a foundling, enter the name of the fetus as provided by state law or rule. 

FOR AN ELECTRONIC RECORD: 

Enter the names of the fetus as recorded in item 1 of the patient’s work sheet. Have the 

patient check the spelling and order of names before entering the names into the 

computer. 

EFR Developer 

The paper fetal death report does not have separate boxes for the names of the fetus. 

However, the patient’s work sheet does have separate spaces for the names. 
Item 1, page 2 

5/2004; Updated 2/18/2005 

The EFR should have separate fields for the first name(s), middle name(s), last 

name(s) (surname), and last name suffix. 

There should also be a check box to indicate if the fetus is a foundling. 

  Check this box if the fetus is a foundling. 

When the name of the fetus screen appears, display the foundling check box first and if 

checked the following instruction should appear. 

 Enter the last name of the fetus as follows: (state should supply) 

If the fetus is to be named the following at the top of the screen until all the name fields 

are completed. 

It is suggested that you print out the name(s) as provided to you by the 

parents and have the parents check the spelling and order of names before 

entering the names into the computer. 

If there appears to be more than one spelling of any name provided and the 

correct spelling cannot be verified, use the most common spelling. 

When completing the first name entry box or the middle name entry box, the following 

message should pop up. 

IF YOU NEED HELP, CHECK THE APPROPRIATE BOX BELOW: 

 Help on multiple first or middle names 

 Initials 

 No first or middle names 

If the first help box is checked, the following instruction appears: 

Multiple first or middle names 

If the parents indicate two first names separated by a space, such as “Mary Louise 

Carter,” verify that “Louise” is part of the first name and is not a middle name. 

Enter the two first names with a blank space between them. 

If several middle names are given, enter all with a space between the names. 

If the second help box is checked, the following instruction appears: 

Initials 
Item 1, page 3 

5/2004; Updated 2/18/2005 

If the parents indicate that the fetus is to have only a first initial such as “E. 

Charles Jones,” enter the E followed by a period. 

If the parents indicate two initials and a last name such as “H.S. Green,” 

determine if these are a first and middle initial, or two first initials with no middle 

name or initial. Enter the initials in the appropriate spaces. Each initial should be 

followed by a period. 

If the third help box is checked, the following instruction appears: 

No first or middle names 

If the child has not been given a first or middle name, leave the first and middle 

name fields blank. 

 

When completing the last name entry, the following message should pop up. 

IF YOU NEED HELP, CHECK THE APPROPRIATE BOX BELOW: 

 Multiple last names 

 Unknown last name (foundling) 

 Special characters in last names 

 Surname suffixes 

If the first help box is checked, the following instruction appears: 

Multiple last names 

If more than one surname is given separated by a hyphen, enter exactly as 

given with the hyphen. If there is more than one last name and no hyphen, 

enter the two names with a space between them. 

If the second help box is checked, the following instruction appears: 

 Unknown last name 

If the last name is unknown (foundling) enter as provided by state law or 

rule, enter “unknown” in the last name field and leave the other fields 

blank. (The state should supply specific instructions for this )

If the third help box is checked, the following instruction appears: 

Special characters in last names 
Item 1, page 4 

5/2004; Updated 2/18/2005 

If the surname has a space or apostrophe following prefixes, such as Mac 

Pherson or O’Toole, enter as given with the space or apostrophe. 

If the fourth help box is checked, the following instruction appears: 

Surname suffixes 

Suffixes and generation identifiers are to be entered in the suffix field. 

PROCESSING VARIABLES: 

NAME DESCRIPTION LENGTH VALUES 

FNAME First name 50 Alpha characters 

MNAME Middle name 100 Alpha characters 

LNAME Last name 50 Alpha characters 

SUFF Last name suffix 20 Alpha characters 

FOUND Foundling indicator 1 N, Default 

 F, Foundling 

EDITS: 

“Unknown” is an acceptable entry for the last name only if the variable FOUND had 

value F. 

If the last name field is blank or has value “Unknown,” all other name fields must be 

blank. 

Name fields must contain English alphabetic characters or be blank. 

STATE DATA FILE CONSIDERATIONS 

It is recommended that states keep name information in as detailed a format as possible. 

For data collected on paper records, keying instructions need to be the same as those for 

the electronic record. 
Item 2, page 1 

5/2004; Updated 2/18/2005 

Item Title: TIME OF DELIVERY (24hr) 

 

Item Number: 2 Report, 17 Facility worksheet 

Description: Hour and minute fetus was delivered. 

Source of Information: 

Preferred Source: Labor and delivery, Mother/patient’s admission 

 history and physical 

Other Source: Attendant (non-facility deliveries only) 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

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

If the time of delivery 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 DELIVERY 

(24hr) 

FOR AN ELECTRONIC RECORD: 

EFDR Developer (Instructions are in Italics)

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

Hour and minute of delivery______________ 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION
Item 2, page 2 

5/2004; Updated 2/18/2005 

TD Hour and minute of delivery 0000-2359, 

 9999 Unknown 

 OR 

 0001-2400, (See Edits) 

 9999 Unknown 

 

 

EDITS: 

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 record 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.” 

- For 1300 to 2359 subtract 1200 hours and add “p.m.” 
Item 2, page 3 

5/2004; Updated 2/18/2005 

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 

TD 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 

5/2004; Updated 2/18/2005 

Item Title: SEX

Item Number: 3 Report, 27 Facility worksheet 

Description: The sex of the fetus 

Source of Information:

Preferred Source: Delivery record, Fetus’s medical record 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

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

determined. 

SEX 

________ 

FOR AN ELECTRONIC RECORD: 

EFDR 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 

 Unknown 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

FSEX The sex of the fetus M Male 

F Female 

U Unknown 

 
Item 3, page 2 

5/2004; Updated 2/18/2005 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAME LENGTH TYPE VALUES

FSEX 1 Alpha character string M, F, U 

EDI TRANSMISSION: 

No standards set yet. 
Item 4, page 1 

5/2004; Updated 2/18/2005 

Item Title: DATE OF DELIVERY (FETUS)

Item Number: 4 Report, 16 Facility worksheet 

Description: The fetus’ date of delivery 

Source of Information:

Preferred Source: Labor and delivery, mother/patient’s admission 

 history and physical 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

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

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

DATE OF DELIVERY (Mo/Day/Yr) 

FOR AN ELECTRONIC RECORD: 

EFDR Developer (Instructions are in Italics)

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

separate fields. 

Month of fetus’ delivery ___ ___ 

Day of fetus’ delivery ___ ___ 

Year of fetus’ delivery ___ ___ ___ ___ 

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

delivery is not known. 
Item 4, page 2 

5/2004; Updated 2/18/2005 

If the date of delivery of the fetus is not known, please ask the patient for the 

delivery date. If the patient is not available, enter the date the fetus was 

found as the date of delivery. 

 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION 

FDOD_YR Year of Delivery 4 digit year Must be equal 

 to current data year 

 

FDOD_MO Month of Delivery 01 January 

 02 February 

 03 March 

 04 April 

 05 May 

 06 June 

 07 July 

 08 August 

 09 September 

 10 October 

 11 November 

 12 December 

FDOD_DY Day of Delivery 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 delivery should be a leap year. If not, an 

error message should appear and ask that the date be corrected. 
Item 4, page 3 

5/2004; Updated 2/18/2005 

The fetus’s date of delivery must be earlier than or the same as the date the record is 

filed. 

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

FDOD_YR 4 Numeric or “date Must be equal to 

 type” current data year 

 

FDOD_MO 2 Numeric or “date 01-12 

 type” 

FDOD_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 
Item 4, page 4 

5/2004; Updated 2/18/2005 

HL7 EDI format. 
Items 5a,6,7,8,9 

Page 1 

5/2004; Updated 2/18/2005 

Item Titles: FACILITY NAME 

 CITY, TOWN OR LOCATION OF DELIVERY 

 COUNTY OF DELIVERY 

 FACILITY ID (NPI) 

 PLACE WHERE DELIVERY OCCURRED

Item Numbers: 5a Report, 3 Facility worksheet 

 6 Report, 4 Facility worksheet 

 7 Report, 5 Facility worksheet 

8 Report, 1 Facility worksheet 

 9 Report, 2 Facility worksheet 

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

 The city, town or location of delivery 

 The county of delivery 

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

 no NPI, the state hospital code 

 The type of place where the delivery occurred 

Source of Information: 

Preferred Source: Admission history and physical, delivery record, 

basic admission data, progress notes 

 Other Source: Attendant (non-facility deliveries only) 

INSTRUCTIONS 

FOR A PAPER RECORD: 

Item 8. 

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

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

number of the place where the delivery occurred. If the delivery occurred en route, that is 

in a moving conveyance, type or print the city, town, village, or location where the fetus 

was first removed from the conveyance. If the delivery occurred in international air 

space or waters enter “plane” or “boat.” 
Items 5a,6,7,8,9 

Page 2 

5/2004; Updated 2/18/2005 

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

Item 5a. 

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

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

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

CITY, TOWN, OR LOCATION OF DELIVERY 

Item 6. 

Type or print the name of the county where the delivery occurred. If the delivery 

occurred in international waters or air space, enter the name of the county where the fetus 

was first removed from the boat or plane. 

COUNTY OF DELIVERY 

Item 9. 

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

hospital code. 

FACILITY ID. (NPI) 

Item 7. 

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

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

PLACE WHERE DELIVERY OCCURRED (Check one) 

 Hospital 

 Freestanding birthing center 

 Home Delivery: Planned to deliver at home?  Yes  No 

 Clinic/Doctor’s office 

 Other (Specify)_____________ 

FOR AN ELECTRONIC RECORD: 

EFDR Developer: (Instructions are in Italics)
Items 5a,6,7,8,9 

Page 3 

5/2004; Updated 2/18/2005 

The initial question should ask if the delivery occurred in this facility, if the answer is “yes,” or “delivered 

en route”, all the items (5,6,7,8,9) 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. 

EFDR 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 delivery 

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 delivery,” 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. 

If the delivery 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 

delivery occurred in an airplane or boat enter boat (lake___) or boat (international 

waters) etc. 

City, town, or location_______________________________________ 
Items 5a,6,7,8,9 

Page 4 

5/2004; Updated 2/18/2005 

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 delivery Alpha/numeric 

CNAME County name where delivery Alpha character string 

 occurred 

CNTYO County code Numeric (Appendix C) 

DPLACE Place of Delivery 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 delivery. 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 Delivery 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 report can be filed or printed (final 

review screen). 

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 delivery occurred at home. 
Items 5a,6,7,8,9 

Page 5 

5/2004; Updated 2/18/2005 

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

to have a home delivery. 

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 

Report item 5a. 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 EFDR 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 Report item 7, 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 

DPLACE 1 Numeric 1-7, 9 

FNPI 12 Alpha/numeric 

SFN 4 Alpha/numeric 

EDI TRANSMISSION: 

No standards set yet. 
Items 10a 

Page 1 

5/2004; Updated 2/18/2005 

Item Title: MOTHER’S CURRENT LEGAL NAME 

(First, Middle, Last, Suffix) (Item is not part of the NCHS data set.)

Item Number: 10a Report, 2 Patient’s Worksheet 

Description: The current legal name of the mother. 

Sources of Information:

Preferred Source: Patient 

 Other Sources: Medical Records 

 Father of child or other relative 

 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Print or type the mother’s current legal First, Middle, and Last Names including suffix. 

 

It is suggested that you print or type the names as provided to you and have the patient 

check the spelling and order of names before entering the names on the certificate. 

If there appears to be more than one spelling of any name provided, and the correct 

spelling cannot be verified, use the most common spelling. 

FOR AN ELECTRONIC RECORD: 

Enter the mother’s current legal name as recorded in item 2 of the patient’s work sheet. 

Have the patient check the spelling and order of names before entering the names into the 

computer. 

EFR Developer 

The paper fetal death report does not have separate boxes for the current legal name of 

the mother. However, the patient’s work sheet does have separate spaces for the names. 
Items 10a 

Page 2 

5/2004; Updated 2/18/2005 

The EFR should have separate fields for the first name(s), middle name(s), last 

name(s) (surname), and last name suffix. 

 

It is suggested that you print out the name(s) as provided to you by the 

patient and have the patient check the spelling and order of names before 

submitting the record to the state. 

If there appears to be more than one spelling of any name provided and the 

correct spelling cannot be verified, use the most common spelling. 

When completing the first name entry box or the middle name entry box, the following 

message should pop up in a manner that does not obscure the item completion screen. 

IF YOU NEED HELP, CHECK THE APPROPRIATE BOX BELOW: 

 Help on multiple first or middle names 

 Initials 

 

If the first help box is checked, the following instruction appears: 

Multiple first or middle names 

If two first names separated by a space, such as “Mary Louise Carter” are 

indicated, verify that “Louise” is part of the first name and is not a middle name. 

Enter the two first names with a blank space between them. 

If several middle names are given, enter all with a space between the names. 

If the second help box is checked, the following instruction appears: 

Initials 

If the mother indicates that she is to have only a first initial such as “E. Mary 

Jones,” enter the E followed by a period. 

If the mother indicates two initials and a last name such as “H.S. Green,” 

determine if these are a first and middle initial, or two first initials with no middle 

name or initial. 

Enter the initials in the appropriate spaces. Each initial should be followed by a 

period. 

If there is a title preceding the name, such as Doctor, do not enter the title in any 

of the name fields. 
Items 10a 

Page 3 

5/2004; Updated 2/18/2005 

When completing the last name entry, the following message should pop up. 

IF YOU NEED HELP, CHECK THE APPROPRIATE BOX BELOW: 

 Multiple last names 

 Special characters in last names 

 Surname suffixes 

If the first help box is checked, the following instruction appears: 

Multiple last names 

If more than one last name is given separated by a hyphen, enter exactly as 

given with the hyphen. If there is more than one last name and no hyphen, 

enter the two names with a space between them. 

If the second help box is checked, the following instruction appears: 

Special characters in last names 

If the last name has a space or apostrophe following prefixes, such as Mac 

Pherson or O’Toole, enter as given with the space or apostrophe. 

If the third help box is checked, the following instruction appears: 

Surname suffixes 

Suffixes and generation identifiers are to be entered in the suffix field. 

PROCESSING VARIABLES: 

NAME DESCRIPTION LENGTH VALUES 

MFNAME First name 50 Alpha characters 

MMNAME Middle name 100 Alpha characters 

MLNAME Last name 50 Alpha characters 

MSUFF Last name suffix 20 Alpha characters 

BOTH ELECTRONIC AND PAPER RECORDS 

Name fields must contain English alphabetic characters or be blank. 
Items 10a 

Page 4 

5/2004; Updated 2/18/2005 

Unless variable FOUND (item 1) has value F, there must be an entry in the last name 

field. Any of the other fields may be blank 

STATE DATA FILE CONSIDERATIONS 

It is recommended that states keep name information in as detailed a format as possible. 

For data collected on paper records, keying instructions need to be the same as those for 

the electronic record. 
Item 10b, page 1 

5/2004; Updated 2/18/2005 

Item Title: DATE OF BIRTH (MOTHER/PATIENT)

Item Number: 10b Report, 6 Patient’s worksheet 

Description: The mother/patient’s date of birth 

Source of Information:

Preferred Source: Mother/patient 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

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

If the patient’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: 

EFDR 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 Patient’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 patient is not known at this time, leave blank. 

Month of patient’s birth ___ ___ 

Day of patient’s birth ___ ___ 

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

5/2004; Updated 2/18/2005 

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 

fetus’s year of 

delivery 

 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 

99 Unknown 
Item 10b, page 3 

5/2004; Updated 2/18/2005 

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 patient’s date of birth (completed dates only) and the fetus’s date 

of delivery. 

Calculated age must be >8 and < 65. 

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

Patient’s age is out of acceptable limits, please check the patient’s date of birth and 

re-enter the date of birth. 

The entry screen for the patient’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 patient are queried. For those records with stated “age of 

patient” 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 10b, page 4 

5/2004; Updated 2/18/2005 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

 NAME LENGTH TYPE VALUES

MDOB_YR 4 Numeric or “date 4 digit year, <fetus’s yr of delivery, 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 10c, page 1 

5/2004; Updated 2/18/2005 

Item Title: MOTHER’S NAME PRIOR TO FIRST 

MARRIAGE (First, Middle, Last, Suffix) (Item is not part of the NCHS data set.)

Item Number: 10c Report, 12 Patient’s Worksheet 

Description: The name of the mother prior to first marriage. 

Sources of Information:

Preferred Source: Patient 

 Other Sources: Medical Records 

 Father of child or other relative 

 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Print or type the mother’s name prior to first marriage, First, Middle, and Last Names 

including suffix. 

 

It is suggested that you print or type the names as provided to you and have the patient 

check the spelling and order of names before entering the names on the certificate. 

If there appears to be more than one spelling of any name provided, and the correct 

spelling cannot be verified, use the most common spelling. 

FOR AN ELECTRONIC RECORD: 

Have the patient check the spelling and order of names before submitting the record to 

the state. 

EFR Developer 

The paper fetal death report does not have separate boxes for the name of the mother 

prior to first marriage. However, the patient’s work sheet does have separate spaces for 

the names. 
Item 10c, page 2 

5/2004; Updated 2/18/2005 

The EFR should have separate fields for the first name(s), middle name(s), last 

name(s) (surname), and last name suffix. 

When the mother’s name prior to first marriage screen appears, display the following 

at the top of the screen until all the name fields are completed. 

It is suggested that you print out the name(s) as provided to you by the 

patient and have the patient check the spelling and order of names before 

entering the names into the computer. 

If there appears to be more than one spelling of any name provided and the 

correct spelling cannot be verified, use the most common spelling. 

When completing the first name entry box or the middle name entry box, the following 

message should pop up in a manner that does not obscure the item completion screen. 

IF YOU NEED HELP, CHECK THE APPROPRIATE BOX BELOW: 

 Help on multiple first or middle names 

 Initials 

  Titles 

If the first help box is checked, the following instruction appears: 

Multiple first or middle names 

If two first names separated by a space, such as “Mary Louise Carter” are 

indicated, verify that “Louise” is part of the first name and is not a middle name. 

Enter the two first names with a blank space between them. 

If several middle names are given, enter all with a space between the names. 

If the second help box is checked, the following instruction appears: 

Initials 

If the mother indicates only a first initial such as “E. Mary Jones,” enter the E 

followed by a period. 

If the mother indicates two initials and a last name such as “H.S. Green,” 

determine if these are a first and middle initial, or two first initials with no middle 

name or initial. 
Item 10c, page 3 

5/2004; Updated 2/18/2005 

Enter the initials in the appropriate spaces. Each initial should be followed by a 

period. 

If the third help box is checked, the following instruction appears: 

Titles 

If there is a title preceding the name, such as Doctor, do not enter the title in any 

of the name fields. 

When completing the last name entry, the following message should pop up. 

IF YOU NEED HELP, CHECK THE APPROPRIATE BOX BELOW: 

 Multiple last names 

 Special characters in last names 

 Surname suffixes 

If the first help box is checked, the following instruction appears: 

Multiple last names 

If more than one last name is given separated by a hyphen, enter exactly as 

given with the hyphen. If there is more than one last name and no hyphen, 

enter the two names with a space between them. 

If the second help box is checked, the following instruction appears: 

Special characters in last names 

If the last name has a space or apostrophe following prefixes, such as Mac 

Pherson or O’Toole, enter as given with the space or apostrophe. 

If the third help box is checked, the following instruction appears: 

Surname suffixes 

Suffixes and generation identifiers are to be entered in the suffix field. 

PROCESSING VARIABLES: 

NAME DESCRIPTION LENGTH VALUES 

MFNAMEP First name 50 Alpha characters 

MMNAMEP Middle name 100 Alpha characters 
Item 10c, page 4 

5/2004; Updated 2/18/2005 

MLNAMEP Last name 50 Alpha characters 

MSUFFP Last name suffix 20 Alpha characters 

EDITS:

BOTH ELECTRONIC AND PAPER RECORDS 

Name fields must contain English alphabetic characters or be blank. 

Unless variable FOUND (item 1) has value F, there must be an entry in the last name 

field. Any of the other name fields may be blank. 

STATE DATA FILE CONSIDERATIONS 

It is recommended that states keep name information in as detailed a format as possible. 

For data collected on paper records, keying instructions need to be the same as those for 

the electronic record. 

. 

 
Item 10d, page 1 

5/2004; Updated 2/18/2005 

Item Title: BIRTHPLACE (STATE, TERRITORY, OR 

FOREIGN COUNTRY)

Item Number: 10d Report, 7 Mother/patient’s worksheet

Description: The geographic location of the mother/patient’s place of 

 birth. 

Source of Information: 

 Preferred Source: Mother/patient 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 patient was born. 

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

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

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

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

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

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

FOR AN ELECTRONIC RECORD: 

EFDR 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 Patient 

(Please enter for only one field) 

Patient’s U.S. State of Birth ___________________ 

OR 
Item 10d, page 2 

5/2004; Updated 2/18/2005 

Patient’s U.S. Territory of Birth _________________ 

OR 

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

 Patient’s birthplace unknown 

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

“Patient’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 patients’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 patient’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 Patient’s state of birth (literal) Literal entry, blank 

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

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

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

BPLACEC_CNT Code for Patient’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 10d, page 3 

5/2004; Updated 2/18/2005 

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 11a-11g, page 1 

5/2004; Updated 2/18/2005 

Item Title: RESIDENCE OF MOTHER/PATIENT: 

STATE 

 COUNTY 

 CITY, TOWN OR LOCATION 

 STREET AND NUMBER 

 APT. NO. 

 ZIP CODE 

 INSIDE CITY LIMITS? 

Item Number: 11a – 11g Report; 3, 4 Mother/patient’s worksheet 

Description: The geographic location of the mother/patient’s residence 

Source of Information:

Preferred Source: Mother/patient or other informant 

INSTRUCTIONS: 

FOR A PAPER RECORD: 

 

Items 11a-11g. 

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

include post office boxes or rural route numbers. 

Item 11a. 

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

recorded. 

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

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

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

by “ / Canada.” 

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

patient’s country of residence. 

RESIDENCE OF PATIENT-STATE 
Item 11a-11g, page 2 

5/2004; Updated 2/18/2005 

Item 11b & 11c. 

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

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

COUNTY CITY, TOWN, OR LOCATION 

Items 11d-11f. 

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

If the patient 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 11g. 

Check whether the patient’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 patient is not a U.S. resident, leave this item blank. 

INSIDE CITY LIMITS? 

 Yes  No 

 

FOR AN ELECTRONIC RECORD: 

EFDR Developer (Instructions are in Italics)

The collection of the patient’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- 
Item 11a-11g, page 3 

5/2004; Updated 2/18/2005 

 direction as South. 

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 patient is the place the patient 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 patients 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 patient’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. Patient’s country of residence_________________ 

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

USA, and “Name of city, town, or other place of residence is not “unknown.” 
Item 11a-11g, page 4 

5/2004; Updated 2/18/2005 

12. Is patient’s place of residence inside the city or town limits? 

 Yes 

 No 

 Unknown 

 

 

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

appear: 

Enter the building number assigned to the patient’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 patient’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.” 
Item 11a-11g, page 5 

5/2004; Updated 2/18/2005 

Example: Walker Street NW. Enter NW in the post-directional space. 

 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 patient 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 patient 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 patient 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. 
Item 11a-11g, page 6 

5/2004; Updated 2/18/2005 

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

previous item, “Canada” will automatically be entered. 

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

name of the patient’s country of residence. 

If the patient’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 patient’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. Patient’s country of residence_________________ 

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

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

10. Is patient’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 patient’s residence. 

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

 If the number is unknown, enter “unknown.” 
Item 11a-11g, page 7 

5/2004; Updated 2/18/2005 

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

appear. 

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

 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 patient 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 patient resides in a Canadian province or Canadian territory, enter the 

name of the province or territory. 
Item 11a-11g, page 8 

5/2004; Updated 2/18/2005 

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. 

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

name of the patient’s country of residence. 

If the patient’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 
Item 11a-11g, page 9 

5/2004; Updated 2/18/2005 

TRANSLATIONS 

Response Mapping (examples) 

 Response Maps to values

Country Name Appendix A to be superseded by 

NCHS Part 8 

FIPS10-4 two character codes

State/Province Name Appendix B to be superseded by 

NCHS Part 8 

FIPS 5-2 two character codes or 

Canadian two character postal codes

City/Town Name Appendix C to be superseded by 

NCHS Part 8 

FIPS 55-3 five digit place codes 

County Name Appendix C to be superseded by 

NCHS Part 8 

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 
Item 11a-11g, page 10 

5/2004; Updated 2/18/2005 

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

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 
Item 11a-11g, page 11 

5/2004; Updated 2/18/2005 

 Post-directional POSTDIR 10 

 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 12a, page 1 

5/2004; Updated 2/18/2005 

Item Title: FATHER’S CURRENT LEGAL NAME (First, 

Middle, Last, Suffix) 

(Item is not part of the NCHS data set.)

Item Number: 12a Report, 14 Patient’s Worksheet 

Description: The current legal name of the father. 

Sources of Information:

Preferred Source: Patient 

 Other Sources: Medical Records 

 Father of child or other relative 

 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Print or type the father’s current legal First, Middle, and Last Names including suffix. 

State law or rule may dictate the conditions when a father can be named, and the name of 

the man to be entered as the father on a fetal death report.

 

It is suggested that you print or type the names as provided to you and have the patient or 

father check the spelling and order of names before entering the names on the certificate. 

If there appears to be more than one spelling of any name provided, and the correct 

spelling cannot be verified, use the most common spelling. 

FOR AN ELECTRONIC RECORD: 

Enter the father’s current legal name as recorded in item 14 of the patient’s work sheet. 

Have the patient or father check the spelling and order of names before entering the 

names into the computer. 

EFR Developer 

The paper fetal death report does not have separate boxes for the current legal name of 

the father. However, the patient’s work sheet does have separate spaces for the names. 

The EFR should have separate fields for the first name(s), middle name(s), last 

name(s) (surname), and last name suffix. 
Item 12a, page 2 

5/2004; Updated 2/18/2005 

The father’s current legal name screen should appear: 

1. Only if item 22 on the certificate (13 on the patient’s work sheet), was the patient 

married at birth, conception or any time between is checked “Yes,” OR 

2. As otherwise specified by state rule or law. 

If a father’s name cannot be entered, the fields should be left blank. 

When the father’s current legal name screen appears, display the following at the top 

of the screen until all the name fields are completed. 

It is suggested that you print out the name(s) as provided to you by the 

patient and have the patient check the spelling and order of names before 

submitting the report to the state. 

If there appears to be more than one spelling of any name provided and the 

correct spelling cannot be verified, use the most common spelling. 

When completing the first name entry box or the middle name entry box, the following 

message should pop up. 

IF YOU NEED HELP, CHECK THE APPROPRIATE BOX BELOW: 

 Help on multiple first or middle names 

 Initials 

 Titles 

If the first help box is checked, the following instruction appears: 

Multiple first or middle names 

If two first names separated by a space, such as “ Billy Bob Carter” are indicated, 

verify that “Bob” is part of the first name and is not a middle name. 

Enter the two first names with a blank space between them. 

If several middle names are given, enter all with a space between the names. 

If the second help box is checked, the following instruction appears: 

Initials 

If only a first initial such as “J. Jones,” is indicated enter the J. followed by a 

period. 
Item 12a, page 3 

5/2004; Updated 2/18/2005 

If the patient indicates two initials and a last name such as “J. S. Green,” 

determine if these are a first and middle initial, or two first initials with no middle 

name or initial. 

Enter the initials in the appropriate spaces. Each initial should be followed by a 

period. 

If the third box is checked, the following instruction appears: 

Titles 

If there is a title preceding the name, such as Doctor, do not enter the title in any 

of the name fields. 

When completing the last name entry, the following message should pop up. 

IF YOU NEED HELP, CHECK THE APPROPRIATE BOX BELOW: 

 Multiple last names 

 Special characters in last names 

 Surname suffixes 

If the first help box is checked, the following instruction appears: 

Multiple last names 

If more than one last name is given separated by a hyphen, enter exactly as 

given with the hyphen. If there is more than one last name and no hyphen, 

enter the two names with a space between them. 

If the second help box is checked, the following instruction appears: 

Special characters in last names 

If the last name has a space or apostrophe following prefixes, such as Mac 

Pherson or O’Toole, enter as given with the space or apostrophe. 

If the third help box is checked, the following instruction appears: 

Surname suffixes 

Suffixes and generation identifiers are to be entered in the suffix field. 
Item 12a, page 4 

5/2004; Updated 2/18/2005 

PROCESSING VARIABLES: 

NAME DESCRIPTION LENGTH VALUES 

FFNAME First name 50 Alpha characters 

FMNAME Middle name 100 Alpha characters 

FLNAME Last name 50 Alpha characters 

FSUFF Last name suffix 20 Alpha characters 

EDITS: 

If the father cannot be named by law or rule, all name fields must be blank 

If the variable FOUND (item 1) has value “F,” all fields may be blank 

If the last name field is blank, all other name fields must be blank.

All name fields must contain English alphabetic characters if not blank. 

STATE DATA FILE CONSIDERATIONS 

It is recommended that states keep name information in as detailed a format as possible. 

For data collected on paper records, keying instructions need to be the same as those for 

the electronic record. 

. 

 

 
Item 12b, page 1 

5/2004; Updated 2/18/2005 

Item Title: DATE OF BIRTH (FATHER)

Item Number: 12b Report, 15 Mother/patient’s worksheet 

Description: The father’s date of birth 

Source of Information:

Preferred Source: Mother/patient 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: 

EFDR 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 12b, page 2 

5/2004; Updated 2/18/2005 

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 

delivery 

 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 12b, page 3 

5/2004; Updated 2/18/2005 

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 delivery 

date. 

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 delivery. 

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 12b, page 4 

5/2004; Updated 2/18/2005 

 NAME LENGTH TYPE VALUES

FDOB_YR 4 Numeric or “date 4 digit year <Year of delivery, 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 12c, page 1 

5/2004; Updated 2/18/2005 

 

Title: BIRTHPLACE (STATE, TERRITORY, OR 

FOREIGN COUNTRY) 

(Item is not part of the NCHS data set.)

Item number: 12c Report, 16 Patient’s worksheet

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

Source of information: 

 Preferred Source: Patient or other informant 

INSTRUCTIONS 

FOR A PAPER RECORD: 

Complete this item only if a father is named on the record. 

Print or type the name of the U.S. State, U.S. Territory in which the father was born. If 

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

father was born. U.S. Territories are: Puerto Rico, U.S. Virgin Islands, Guam, American 

Samoa, and Northern Marianas. If the father’s birthplace is not known print or type 

“Unknown” in the space. (note: Canadian Provinces and Canadian Territories are not 

collected for father’s place of birth) 

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

______________________________________ 

 

FOR AN ELECTRONIC RECORD: 

EFR developer: 

There should be a screen with separate entry spaces for, state of birth, territory of birth 

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

below. 

Birthplace of Father 

Father’s State of Birth ___________________ 

OR 
Item 12c, page 2 

5/2004; Updated 2/18/2005 

 Father’s Territory of Birth_________________ 

 OR 

 Father’s Country of Birth___________________ 

 Father’s birthplace unknown 

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

worksheet item is blank, check the “Father’s birthplace unknown” box. 

 

As soon as an entry is made in any one of the fields the screen changes to the next item 

on the worksheet to avoid entries in the remaining two fields. 

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

(BPLACE_ST_TER) 

. 

PROCESSING VARIABLES: 

 NAME: DESCRIPTION LENGTH VALUES 

 

FBPLACE_ST_TER_L Father’s state or 30 Alpha character 

 Territory of birth 

FBPLACE_CNT_L Father’s country of birth 30 Alpha character 

EDITS: 

If variable FBPLACE_ST_TER_L is not blank, FBPLACE_CNT_L must be blank. The 

reverse also holds. If variable FBPALCE_CNT_L has an entry, variable 

FBPLACE_ST_TER_L must be blank. 

Father’s State or Territory of birth must be a U.S. State or Territory 

All fields can be blank 

STATE DATA FILE CONSIDERATIONS 

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

PROCESSING VARIABLES: 

 NAME DESCRIPTION LENGTH VALUES 
Item 12c, page 3 

5/2004; Updated 2/18/2005 

FBPLACE_ST_TER_C Code for Father’s 2 Appendix B 

 State or Territory of birth 

FBPLACE_CNT_C Code for Father’s 2 Appendix A 

 country of birth 

Literal entries for U.S. States and U.S. Territories should be assigned using FIPS 5-2two 

character codes (Appendix B). 

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

codes (Appendix A). 

If the “ unknown” box is checked, the value ZZ is assigned to all fields. 

 

 
Item 13, page 1 

5/2004; Updated 2/18/2005 

Item Title: METHOD OF DISPOSITION (Item is not part of the NCHS data set.)

Item Number: 13 Report, 32 Facility Worksheet 

Description: Method of final disposition of the 

dead fetus 

Source of Information:

Preferred Source: Facility 

 Funeral Director 

 Other person authorized to dispose of a dead fetus

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Person completing the Report of Fetal Death 

 

Response is based on wishes of the next of kin or informant. 

Check the appropriate box (see below). 

If the box labeled “Other” is chosen, print the method of disposition. 

 Burial 

 Cremation 

 Hospital disposition 

 Donation 

 Removal from State 

 Other (Specify)_____________
Item 13, page 2 

5/2004; Updated 2/18/2005 

FOR AN ELECTRONIC RECORD: 

EFR Developer 

Method of disposition is to be selected from the menu below based on the information in 

the facility work sheet or other acceptable source. Only one check box is allowed. 

Method of Disposition 

 Burial 

 Cremation 

 Hospital disposition 

 Donation 

 Removal from State 

 Other 

If the “other” response is selected, a place to enter the “other” method of disposition 

appears. 

Please describe the other type of disposition. 

Other (specify)________________________ 

PROCESSING VARIABLE: 

NAME DESCRIPTION LENGTH VALUES 

DISP Method of disposition 1 B Burial 

 C Cremation 

 H Hospital disposition 

 D Donation 

 R Removal from State 

O Other 

X Unknown 

ELECTRONIC RECORD 

Electronic record must contain one of the responses indicated above. If not, query screen 

appears before record can be printed or filed. Same screen as entry screen appears and 

indicates that one of the categories below must be selected before the record can be 

printed or filed. 

PAPER RECORD 
Item 13, page 3 

5/2004; Updated 2/18/2005 

Records filed with this field blank are queried. If no response to query, assign the 

“Unknown” code. 

If multiple methods are reported, states may elect to record the multiple responses or 

select a single response. Order of preference from most preferred to least is as follows: 

burial, cremation, hospital disposition, donation, removal from State, other. 

 

STATE FILE CONSIDERATIONS 

States may opt to electronically record the “Other (specify)” methods. This will be 

needed if copies are to be issued from the electronic file. It is recommended that this be a 

30-character field 

PROCESSING VARIABLE: 

NAME DESCRIPTION LENGTH VALUES 

DISPL Method of disposition 30 Alpha characters 
Item 14, page 1 

5/2004; Updated 2/18/2005 

Item Title: ATTENDANT’S NAME, TITLE, AND NPI 

Item Number: 14 Report, 21 Facility worksheet

 

Description: The name of the attendant (the person responsible for delivering 

the fetus), 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 a fetus 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 delivery 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 delivery 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 14, page 2 

5/2004; Updated 2/18/2005 

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: 

EFDR Developer (Instructions are in italics) 

The following definition should be available in the help function: 

The attendant at delivery 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 delivery 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 

attendants. But, this approach could easily lead to errors that cannot be caught or 

edited. 
Item 14, page 3 

5/2004; Updated 2/18/2005 

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 

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 

NPI National provider Alpha/numeric 
Item 14, page 4 

5/2004; Updated 2/18/2005 

 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 14, page 5 

5/2004; Updated 2/18/2005 

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 15, page 1 

5/2004; Updated 2/18/2005 

Item Title: NAME TITLE OF PERSON COMPLETING 

REPORT (Item is not part of the NCHS data set.)

Item Number: 15 Report, 28 Facility Worksheet 

Description: The name and title of the person completing the report of fetal 

death.

Sources of Information:

Preferred Source: Person completing the report 

 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Print or type the name of the person completing the report and their title. 

NAME AND TITLE OF PERSON COMPLETING REPORT 

NAME_________________ 

TITLE_________________ 

FOR AN ELECTRONIC RECORD: 

Enter the name of the person completing the report as recorded in item 18 of the facility work 

sheet. 

EFR Developer 

The paper report of fetal death does not have separate boxes for the names of the person 

completing the report. Nor does, the facility work sheet have separate spaces for the names. 

The EFR should have separate fields for the first /middle name(s), last name(s) (surname). 

The developer may elect to record the names in separate fields or parse the names after entry 

to separate the first/middle name(s) from the last name. 
Item 15, page 1 

5/2004; Updated 2/18/2005 

The developer may elect to record the first and middle names separately
Item 15, page 2 

5/2004; Updated 2/18/2005 

The title of the person shall be recorded as entered and can be blank. 

PROCESSING VARIABLES: 

NAME DESCRIPTION LENGTH VALUES 

 

REPFNAME First name and middle name 50 Alpha characters 

REPLNAME Last name 50 Alpha characters 

REPTITLE Title of the person completing 50 Alpha character 

 the report 

EDITS: 

States may want to compare the name of the person completing the report with a list of approved 

persons either for the state as a whole or by facility in order to prevent the fraudulent filing of a 

report of fetal death. Records completed by a person not approved should not be accepted 

without a query. 

BOTH ELECTRONIC AND PAPER RECORDS 

Name fields must contain English alphabetic characters. 

There must be an entry in the last name field. The first/middle name field can be blank 

The title may be blank. 

STATE DATA FILE CONSIDERATIONS 

It is recommended that states keep name information in as detailed a format as possible. For data 

collected on paper records, keying instructions need to be the same as those for the electronic 

record. 
Item 16, page 1 

5/2004; Updated 2/18/2005 

Item Title: DATE REPORT COMPLETED (Item is not part of the NCHS data set.)

Item Number: 16 Report, 19 Facility worksheet 

Description: The date the Report of Fetal Death is Completed 

Source of Information:

Preferred Source: Person completing the report 

INSTRUCTIONS 

FOR A PAPER RECORD: 

Print or type the month, day, and four digit year the report is completed. Standard numeric 

abbreviations are acceptable. 

DATE REPORT COMPLETED (Mo/Day/Yr) 

___________________________ 

FOR AN ELECTRONIC RECORD: 

EFR Developer (Instructions are in italics) 

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

separate fields. 

Month reported___ ___ 

Day reported___ ___ 

Year reported___ ___ ___ ___ 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES LENGTH DEFINITIONS 

REP_YR Year reported 4 digit year 4 4 digit year 

 

REP_MO Month reported 01 2 January 

 02 February 

 03 March 

 04 April 

 05 May 
Item 16, page 2 

5/2004; Updated 2/18/2005 

 06 June 

 07 July 

 08 August 

 09 September 

 10 October 

 11 November 

 12 December, 

REP_DY Day reported 01-31 2 January 1-31 

 February 1-29 

 March 1-31 

 April 1-30 

 May 1-31 

 June 1-30 

 July 1-31 

 August 1-31 

 September 1-30 

 October 1-31 

 November 1-30 

 December 1-31 

 

 

EDITS: 

ELECTRONIC RECORD 

If month is February and day = 29, Date Report Completed should be a leap year. If not, an 

error message should appear and ask that the date be corrected. 

Date Report Completed must be the same as or later than the Date of Delivery (Item 4) and the 

same as or earlier than the Date Received By Registrar (Item 17). 

Paper Records 

For paper records, the same edits are applied. 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 DATA 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 16, page 3 

5/2004; Updated 2/18/2005 

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 17, page 1 

5/2004; Updated 2/18/2005 

Item Title: DATE RECEIVED BY REGISTRAR (Item is not part of the NCHS data set.) 

Item Number: 17 Report 

Description: The date the fetal death report is received by the registrar 

Source of Information:

Preferred Source: Registrar 

INSTRUCTIONS 

FOR A PAPER RECORD: 

Print, type, or stamp the month, day, and four digit year the fetal death report is received by the 

registrar. The format for this is a state issue but , standard numeric abbreviations are not 

recommended. 

DATE RECEIVED BY REGISTRAR (Mo/Day/Yr) 

___________________________ 

FOR AN ELECTRONIC RECORD: 

EFR Developer (Instructions are in italics) 

Each registration district will determine how the date shall be assigned electronically for their 

system. The date the record is completed and accepted by the registrar is a logical choice. 

However, depending on the characteristics of the registration system, some other options may 

be appropriate. 

The Date Received By Registrar item is a three-field entry with the month, day, and year 

entered in separate fields. 

Month received___ ___ 

Day received__ ___ 

Year received___ ___ ___ ___ 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES LENGTH DEFINITIONS 

REC_YR Year received 4 digit year 4 4 digit year 
Item 17, page 2 

5/2004; Updated 2/18/2005 

 

REC_MO Month received 01 2 January 

 02 February 

 03 March 

 04 April 

 05 May 

 06 June 

 07 July 

 08 August 

 09 September 

 10 October 

 11 November 

 12 December, 

REC_DY Day received 01-31 2 January 1-31 

 February 1-29 

 March 1-31 

 April 1-30 

 May 1-31 

 June 1-30 

 July 1-31 

 August 1-31 

 September 1-30 

 October 1-31 

 November 1-30 

 December 1-31 

 

 

EDITS: 

ELECTRONIC RECORD 

If month is February and day = 29, Date Received By Registrar should be a leap year. If not, an 

error message should appear and ask that the date be corrected. 

Date Received By Registrar must be the same as or later than the Date of Delivery (Item 4) and 

the same as or later than the Date Report Completed (Item 16). 

Paper Records 

For paper records, the same edits are applied. 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 DATA FILE CONSIDERATIONS 
Item 17, page 3 

5/2004; Updated 2/18/2005 

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. 

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 18a,18b, page 1 

5/2004; Updated 2/18/2005 

Item Title: CAUSE/CONDITIONS CONTRIBUTING TO 

 FETAL DEATH 

Item Number: 18a Report; 33 facility worksheet 

18b Report; 34 facility worksheet 

Description: Causes of death are diseases, abnormalities, injuries, or 

poisonings that contributed to fetus’ death. 

Source of Information: 

Attending Physician or Medical Examiner/Coroner 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Physician/Medical Examiner 

The cause-of-death section consists of two parts. The initiating cause/condition (18a) is for reporting a single 

condition that most likely began the sequence of events resulting in the death of the fetus. Other significant causes 

or conditions (18b) include all other conditions contributing to death. These conditions may be conditions that are 

triggered by the initiating cause (18a) or causes that are not among the sequence of events triggered by the initiating 

cause (18a). 

The cause-of-death information should be your best medical opinion. Report a specific condition in the space most 

appropriate to the given situation. A condition can be listed as “probable” even if it has not been definitively 

diagnosed. In reporting the causes of fetal death, conditions in the fetus or patient, or of the placenta, cord, or 

membranes, should be reported if they are believed to have adversely affected the fetus. 

Cause of fetal death should include information provided by the pathologist if tissue analysis, autopsy, or another 

type of postmortem exam was done. If microscopic exams for a fetal death are still pending at the time the report is 

filed, the additional information should be reported to the registrar as soon as it is available. 

Cause of death is used for medical and epidemiological research on disease etiology and evaluating the effectiveness 

of diagnostic and therapeutic techniques. It is a measure of health status at local, state, national, and international 

levels. 

When a death occurs without medical attendance at or immediately after the delivery, or when further investigation 

is required by State regulations, a medical examiner or coroner may investigate the fetal death. Report the death to 

the medical examiner or coroner as required by State law. The medical examiner or coroner will either complete the 

cause-of-death section of the fetal death report or waive that responsibility. If the medical examiner does not accept 

the case, then the certifier will need to complete the fetal cause-of-death section. 

General instructions for completing cause of fetal death 
Item 18a,18b, page 2 

5/2004; Updated 2/18/2005 

(For an expanded set of instructions, refer to the State vital statistics office, handbooks, and other resources at 

http://www.cdc.gov/nchs/about/major/dvs/handbk.htm, or NCHS, Room 820, 6525 Belcrest Road, Hyattsville, 

Maryland 20782). 

 Cause-of-death information should be your best medical opinion. 

 Abbreviations and parentheses should be avoided in reporting causes of death. 

 The original fetal death report should be amended if additional medical information or 

autopsy or histological placental findings become available that would change the cause of 

death originally reported. 

 For unattended fetal deaths, report to the medical examiner or coroner in accordance with 

State regulations. 

 The terminal event should not be used. You should report the initiating cause of the terminal 

event in 18a. 

 If an organ system failure is listed as a cause of death, always report its etiology. 

 Always report the fatal injury (e.g., stab wound of patient’s abdomen), the trauma, and 

impairment of function. 

 In 18b, report all diseases or conditions contributing to death that were not reported in 18a 

and that did not result in the initiating cause of death. 

 If two or more possible sequences resulted in death, or if two conditions seem to have added 

together, report in 18a the one that, in your opinion, most directly caused death. Report in 

18b the other conditions or diseases. 

FOR AN ELECTRONIC RECORD: 

EDR Developer 

When the cause-of-death section of the electronic fetal death report is opened or accessed, the first screen to appear 

should read as follows: 

A fetal death report provides important information used for medical and epidemiological 

research on disease etiology and evaluating the effectiveness of diagnostic and therapeutic 

techniques. It is a measure of health status at local, state, national, and international levels. 

The cause-of-death section consists of two parts. The initiating cause/condition (18a) is for 

reporting a single condition that most likely began the sequence of events resulting in the death 

of the fetus. Other significant causes or conditions (18b) include all other conditions 

contributing to death. These conditions may be conditions that are triggered by the initiating 

cause (18a) or causes that are not among the sequence of events triggered by the initiating cause 

(18a). 

The cause-of-death information should be your best medical opinion. Report a specific condition in the space 

most appropriate to the given situation. A condition can be listed as “probable” even if it has not been 

definitively diagnosed. In reporting the causes of fetal death, conditions in the fetus or patient, or of the 

placenta, cord, or membranes, should be reported if they are believed to have adversely affected the fetus. 

Cause of fetal death should include information provided by the pathologist if tissue analysis, 

autopsy, or another type of postmortem exam was done. If microscopic exams for a fetal death 
Item 18a,18b, page 3 

5/2004; Updated 2/18/2005 

are still pending at the time the report is filed, the additional information should be reported to 

the registrar as soon as it is available. 

Physician’s responsibility

The physician’s primary responsibility in completing the cause-of-death section is to report to the best of his 

or her knowledge, based upon available information, the initiating condition that most likely began the 

sequence of events resulting in the death of the fetus and other contributing causes or conditions. 

Medical examiner or coroner’s responsibility

When a death occurs without medical attendance at or immediately after the delivery, or when 

further investigation is required by State regulations, a medical examiner or coroner may 

investigate the fetal death. Report the death to the medical examiner or coroner as required by 

State law. The medical examiner or coroner will either complete the cause-of-death section of 

the fetal death report or waive that responsibility. If the medical examiner does not accept the 

case, then the attending physician will need to complete the fetal cause-of-death section. 

General instructions for completing cause of fetal death (For an expanded set of instructions, click on help) 

 Cause-of-death information should be your best medical opinion. 

 Abbreviations and parentheses should be avoided in reporting causes of death. 

 The original fetal death report should be amended if additional medical information or 

autopsy or histological placental findings become available that would change the cause 

of death originally reported. 

 For unattended fetal deaths, report to the medical examiner or coroner in accordance 

with State regulations. 

 The terminal event should not be used. You should report the initiating cause of the 

terminal event in 18a. 

 If an organ system failure is listed as a cause of death, always report its etiology. 

 Always report the fatal injury (e.g., stab wound of patient’s abdomen), the trauma, and 

impairment of function. 

 In 18b, report all diseases or conditions contributing to death that were not reported in 

18a and that did not result in the initiating cause of death. 

 If two or more possible sequences resulted in death, or if two conditions seem to have 

added together, report in 18a the one that, in your opinion, most directly caused death. 

Report in 18b the other conditions or diseases. 

On medical examiner (ME), coroner, and physician entry screens of the EFDR, 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 2003 revision of the U.S. Standard Report of Fetal Death (as shown below). These medical certifiers 

need to be able to see that they will be completing both 18a and 18b of the fetal death report. The EFDR provides 

the opportunity to provide additional space and instructions. Additional lines may be added. 
Item 18a,18b, page 4 

5/2004; Updated 2/18/2005 

 18. CAUSE/CONDITIONS CONTRIBUTING TO FETAL DEATH

18a. INITIATING CAUSE/CONDITION 

(AMONG THE CHOICES BELOW, PLEASE SELECT THE 

ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF 

EVENTS RESULTING IN THE DEATH OF THE FETUS)

Maternal Conditions/Diseases 

(Specify)___________________________________ 

Complications of Placenta, Cord or Membranes 

9 Rupture of membranes prior to onset of labor 

9 Abruptio placenta 

9 Placental insufficiency 

9 Prolapsed cord 

9 Chorioamnionitis 

9 Other (Specify)_____________________________ 

Other Obstetrical or Pregnancy Complications 

(Specify)____________________________________ 

Fetal Anomaly (Specify)________________________ 

 __________________________________________ 

Fetal Injury (Specify)__________________________ 

Fetal Infection (Specify)________________________ 

Other Fetal Conditions/Disorders 

 (Specify)___________________________________ 

9 Unknown

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS 

(SELECT OR SPECIFY ALL OTHER CONDITIONS 

CONTRIBUTING TO DEATH IN ITEM 18b)

Maternal Conditions/Diseases 

 (Specify)__ __________________________________ 

 _____________________________________________ 

Complications of Placenta, Cord or Membranes 

9 Rupture of membranes prior to onset of labor 

9 Abruptio placenta 

9 Placental insufficiency 

9 Prolapsed cord 

9 Chorioamnionitis 

9 Other (Specify)_______________________________ 

Other Obstetrical or Pregnancy Complications 

(Specify)_____________________________________ 

Fetal Anomaly (Specify)_________________________ 

 ___________________________________________ 

 ___________________________________________ 

Fetal Injury (Specify)____________________________ 

Fetal Infection (Specify)_________________________ 

Other Fetal Conditions/Disorders 

 (Specify)____________________________________ 

9 Unknown

 

Each page should include a context sensitive progress bar (or mouse-over or some alternative pop-up) that provides 

an instruction or definition as the cursor moves from item to item. When the cursor moves to the cause-of-death 

boxes representing 18a of the standard certificate of death, the progress bar or other alternative should have a 

status message that says:

Report the single initiating condition. Click on Help for examples and assistance. 

When cursor is on the entry box representing information collected on 18b of the fetal death report, the status 

message on the progress bar should read: 

Report conditions that contributed to death, but were not reported in 18a, as reported above. 

Click on Help for examples and assistance. 
Item 18a,18b, page 5 

5/2004; Updated 2/18/2005 

INFORMATION THAT SHOULD BE INCLUDED IN THE HELP FUNCTION 

The following shows the structure and content of the Help Section. When the user clicks on Help from an item, the 

Help screen that appears should show the section of Help that is relevant to that item as well as the index of the 

Help Section that would permit them to navigate elsewhere within the Help. This will provide assistance for the 

item in question as well as letting them know that the additional topics are addressed in Help. 

[Certifier- Guidance on getting to help should be prominent on every screen; within the help section, the index 

should be prominent:] 

Index of Help Section: 

Introduction to completing a cause-of-death statement 

Examples of properly completed cause-of-death statements 

Detailed instructions 

Glossary of terms 

Possible solutions to common problems in death certification 

 Uncertainty 

 Avoid ambiguity 

References
Item 18a,18b, page 6 

5/2004; Updated 2/18/2005 

Introduction to completing a cause-of-death statement

One purpose of the fetal death report is to obtain a simple description of the conditions contributing to death 

rather than a record describing all medical conditions present at death.

Causes of death on the fetal death report represent a medical opinion that might vary among individual 

physicians. In signing the fetal death report, the physician, medical examiner, or coroner certifies that, in 

his/her medical opinion, the individual died from the reported causes of death. The certifier’s opinion and 

confidence in that opinion are based upon his/her training, knowledge of medicine, available medical records, 

symptoms, diagnostic tests, and available autopsy or histological placental results for the fetus. Even if 

extensive information is available to the certifier, causes of death may be difficult to determine, so the 

certifier may indicate uncertainty by qualifying the causes on the fetal death report. 

Cause-of-fetal-death data is important for surveillance, research, design of public health and medical 

interventions, and funding decisions for research and development. 

Examples of properly completed cause-of-fetal-death statements

The following are examples of properly completed fetal death reports: 
Item 18a,18b, page 7 

5/2004; Updated 2/18/2005 

Example 1: 

 18. CAUSE/CONDITIONS CONTRIBUTING TO FETAL DEATH

18a. INITIATING CAUSE/CONDITION 

(AMONG THE CHOICES BELOW, PLEASE SELECT THE 

ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF 

EVENTS RESULTING IN THE DEATH OF THE FETUS)

Maternal Conditions/Diseases 

(Specify)___Maternal drug abuse____________________ 

Complications of Placenta, Cord or Membranes 

9 Rupture of membranes prior to onset of labor 

9 Abruptio placenta 

9 Placental insufficiency 

9 Prolapsed cord 

9 Chorioamnionitis 

9 Other (Specify)_____________________________ 

Other Obstetrical or Pregnancy Complications 

(Specify)____________________________________ 

Fetal Anomaly (Specify)________________________ 

 __________________________________________ 

Fetal Injury (Specify)__________________________ 

Fetal Infection (Specify)________________________ 

Other Fetal Conditions/Disorders 

 (Specify)___________________________________ 

9 Unknown

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS 

(SELECT OR SPECIFY ALL OTHER CONDITIONS 

CONTRIBUTING TO DEATH IN ITEM 18b)

Maternal Conditions/Diseases 

 (Specify)__ __________________________________ 

 _____________________________________________ 

Complications of Placenta, Cord or Membranes 

9 Rupture of membranes prior to onset of labor 

9 Abruptio placenta 

9 Placental insufficiency 

9 Prolapsed cord 

9 Chorioamnionitis 

9 Other (Specify)_______________________________ 

Other Obstetrical or Pregnancy Complications 

(Specify)_____________________________________ 

Fetal Anomaly (Specify)_________________________ 

 __________Anencephaly_______________________ 

 ___________________________________________ 

Fetal Injury (Specify)____________________________ 

Fetal Infection (Specify)_________________________ 

Other Fetal Conditions/Disorders 

 (Specify)____________________________________ 

9 Unknown

 

Example 2: 

 18. CAUSE/CONDITIONS CONTRIBUTING TO FETAL DEATH

18a. INITIATING CAUSE/CONDITION 

(AMONG THE CHOICES BELOW, PLEASE SELECT THE 

ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF 

EVENTS RESULTING IN THE DEATH OF THE FETUS)

Maternal Conditions/Diseases 

(Specify)___________________________________ 

Complications of Placenta, Cord or Membranes 

9 Rupture of membranes prior to onset of labor 

9 Abruptio placenta 

9 Placental insufficiency 

9 Prolapsed cord 

9 Chorioamnionitis 

9 Other (Specify)_____________________________ 

Other Obstetrical or Pregnancy Complications 

(Specify)____________________________________ 

Fetal Anomaly (Specify)________________________ 

 __________________________________________ 

Fetal Injury (Specify)__________________________ 

Fetal Infection (Specify)________________________ 

Other Fetal Conditions/Disorders 

 (Specify)____Asphyxia________________________ 

9 Unknown

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS 

(SELECT OR SPECIFY ALL OTHER CONDITIONS 

CONTRIBUTING TO DEATH IN ITEM 18b)

Maternal Conditions/Diseases 

 (Specify)___Homicide by stabbing_________________ 

 _____________________________________________ 

Complications of Placenta, Cord or Membranes 

9 Rupture of membranes prior to onset of labor 

9 Abruptio placenta 

9 Placental insufficiency 

9 Prolapsed cord 

9 Chorioamnionitis 

9 Other (Specify)_______________________________ 

Other Obstetrical or Pregnancy Complications 

(Specify)_____________________________________ 

Fetal Anomaly (Specify)_________________________ 

 ___________________________________________ 

 ___________________________________________ 

Fetal Injury (Specify)____________________________ 

Fetal Infection (Specify)_________________________ 

Other Fetal Conditions/Disorders 

 (Specify)____________________________________ 

9 Unknown

 
Item 18a,18b, page 8 

5/2004; Updated 2/18/2005 

Example 3: 

 18. CAUSE/CONDITIONS CONTRIBUTING TO FETAL DEATH

18a. INITIATING CAUSE/CONDITION 

(AMONG THE CHOICES BELOW, PLEASE SELECT THE 

ONE WHICH MOST LIKELY BEGAN THE SEQUENCE OF 

EVENTS RESULTING IN THE DEATH OF THE FETUS)

Maternal Conditions/Diseases 

(Specify)___________________________________ 

Complications of Placenta, Cord or Membranes 

9 Rupture of membranes prior to onset of labor 

9 Abruptio placenta 

9 Placental insufficiency 

9 Prolapsed cord 

9 Chorioamnionitis 

9 Other (Specify)_____________________________ 

Other Obstetrical or Pregnancy Complications 

(Specify)____________________________________ 

Fetal Anomaly (Specify)________________________ 

 _Triploidy syndrome, XXY_____________________ 

Fetal Injury (Specify)__________________________ 

Fetal Infection (Specify)________________________ 

Other Fetal Conditions/Disorders 

 (Specify)___________________________________ 

9 Unknown

18b. OTHER SIGNIFICANT CAUSES OR CONDITIONS 

(SELECT OR SPECIFY ALL OTHER CONDITIONS 

CONTRIBUTING TO DEATH IN ITEM 18b)

Maternal Conditions/Diseases 

 (Specify)_____________________________________ 

 _____________________________________________ 

Complications of Placenta, Cord or Membranes 

9 Rupture of membranes prior to onset of labor 

9 Abruptio placenta 

9 Placental insufficiency 

9 Prolapsed cord 

9 Chorioamnionitis 

9 Other (Specify)_______________________________ 

Other Obstetrical or Pregnancy Complications 

(Specify)_____________________________________ 

Fetal Anomaly (Specify)_________________________ 

 ___________________________________________ 

 ___________________________________________ 

Fetal Injury (Specify)____________________________ 

Fetal Infection (Specify)_________________________ 

Other Fetal Conditions/Disorders 

 (Specify)____________________________________ 

9 Unknown

 

 

Detailed instructions

 Cause-of-death information should be your best medical opinion. 

 List only one condition in 18a. 

 Abbreviations and parentheses should be avoided in reporting causes of death. 

 The original fetal death report should be amended by the certifying physician (if 

additional medical information or autopsy or histological placental findings become 

available that would change the cause of death originally reported) by immediately 

reporting the revised cause of death to the State Vital Records Office. 

 Report each disease, abnormality, injury, or poisoning that you believe adversely 

affected the fetus including maternal conditions. A condition can be listed as “probable” 

even if it has not been definitively diagnosed. 

 An initiating condition should be reported in 18a that explains why the fetus died. The 

initiating cause may result in an etiological or pathological sequence as well as a 

sequence in which an earlier condition is believed to have prepared the way for a 

subsequent cause by damage to tissues or impairment of function. 

 If two or more possible sequences resulted in death, report in 18a the initiating condition 

triggering the sequence that, in your opinion, most directly caused death. Report in 18b 

the other conditions or diseases. 

 A specific cause of death should be reported in 18a so there is no ambiguity about the 

etiology of this cause. 

 Conditions or diseases in 18b should contribute to death. 

 Mechanistic terminal events should not be the condition reported in 18a. 

 Always report an etiology for organ system failure such as congestive heart failure, 

hepatic failure, renal failure, or respiratory failure on the lines beneath it. 
Item 18a,18b, page 9 

5/2004; Updated 2/18/2005 

 If, in your opinion, the use of alcohol, tobacco, other substance by the patient, or a recent 

injury caused or contributed to death, then this condition should be reported. 

 When indicating neoplasms as a cause of death, include the following: 1) primary site or 

that the primary site is unknown, 2) benign or malignant, 3) cell type or that the cell type 

is unknown, 4) grade of neoplasm, and 5) part or lobe of organ affected. 

 For unattended fetal deaths, report to the medical examiner or coroner in accordance 

with State regulations. 

 For deaths resulting from injuries, always report the fatal injury event, the trauma, and 

the impairment of function. 

Glossary of terms

Causes of death: The causes of death to be entered on the medical certificate of cause of 

death are all those diseases, morbid conditions or injuries which either initiated or 

contributed to death and the circumstances of the accident or violence which produced 

any such injuries. 

Initiating cause of death: the disease or injury that most likely began the sequence of events resulting in the 

death of the fetus. 
Item 18a,18b, page 10 

5/2004; Updated 2/18/2005 

Possible solutions to common problems in death certification

Uncertainty: 

Often several acceptable ways of writing a cause-of-death statement exist. Optimally, a certifier will be able to 

provide a simple description of the initiating cause and other contributing causes that is etiologically clear and 

to be confident that this is correct. However, realistically, description of the process is sometimes difficult 

because the certifier is not certain. 

In this case, the certifier should think through the causes about which he/she is confident and what possible 

etiologies could have resulted in these conditions. The certifier should select the causes that are suspected to 

have been involved and use words such as “probable” or “presumed” to indicate that the description provided 

is not completely certain. Causes of death on the fetal death report should not include terms such as 

prematurity without explaining the etiology because they have little value for public health or medical 

research. Reporting a cause of fetal death as unknown should be a last resort. 

When a number of conditions or multiple organ/system failure resulted in death, the physician, medical 

examiner, or coroner should choose a single condition which most likely began the sequence of events resulting 

in the fetal death and list the other conditions in 18b of the certification section. “Multiple system failure” 

could be included as an “other significant cause or condition” but also specify the systems involved to ensure 

that the detailed information is captured. Maternal conditions may have initiated or affected the sequence that 

resulted in a fetal death. These maternal conditions should be reported in the cause-of-death statement in 

addition to the fetal causes. 
Item 18a,18b, page 11 

5/2004; Updated 2/18/2005 

Avoid ambiguity: 

Most certifiers will find themselves, at some point, in the circumstance in which they are unable to provide a 

simple description of the process of death. In this situation, the certifier should try to provide an initiating 

condition, qualify the causes about which he/she is uncertain, and be able to explain the certification chosen. 

When conditions such as the following are reported, information about the etiology should be 

reported if possible: 

Unknown Low birth weight 

Prematurity Intrauterine hypoxia 

Immaturity 

If the certifier is unable to determine the etiology of a process such as those shown above, the process must be 

qualified as being of an unknown, undetermined, probable, presumed, or unspecified etiology so it is clear that 

a distinct etiology was not inadvertently or carelessly omitted. 

When indicating neoplasms as a cause of death indicate the following: 1) primary site or that the primary site 

is unknown, 2) benign or malignant, 3) cell type or that the cell type is unknown, 4) grade of a neoplasm, and 5) 

part or lobe of an organ affected. 

References

For detailed information on how to complete the medical certification section of the fetal death 

report, you may refer to: 

 State resources. 

 NCHS’ Medical Examiners’ and Coroners’ Handbook on Death Registration and Fetal 

Death Reporting (available from NCHS or at 

http://www.cdc.gov/nchs/data/misc/hb_me.pdf). 

 NCHS’ Hospitals’ and Physicians’ Handbook on Birth Registration and Fetal Death 

Reporting (available from NCHS or at http://www.cdc.gov/nchs/data/hb_birth.pdf). 
Item 18a,18b, page 12 

5/2004; Updated 2/18/2005 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITIONS

COD18a1 Rupture of membranes prior to onset of Y Rupture box checked 

 labor N Rupure box not checked

COD18a2 Abruptio placenta Y Abruptio box checked 

 N Abruptio box not checked 

COD18a3 Placental insufficiency Y Placental box checked 

 N Placental box not checked 

COD18a4 Prolapsed cord Y Cord box checked 

 N Cord box not checked

COD18a5 Chorioamnionitis Y Chorio box checked 

 N Chorio box not checked

COD18a6 Other complications of placenta, cord, Y Other box checked 

 Or membranes N Other box not checked 

COD18a7 Unknown Y Unknown box checked 

 N Unknown box not checked

COD18a8 Maternal conditions/diseases literal Literal responses 

COD18a9 Other complications of placenta, cord, or Literal responses 

 Membranes literal 

COD18a10 Other obstetrical or pregnancy complications Literal responses 

 literal 

COD18a11 Fetal anomaly literal Literal responses 

COD18a12 Fetal injury literal Literal responses 

COD18a13 Fetal infection literal Literal responses 

COD18a14 Other fetal conditions/disorders literal Literal responses 

COD18b1 Rupture of membranes prior to onset of Y Rupture box checked 

 labor N Rupure box not checked
Item 18a,18b, page 13 

5/2004; Updated 2/18/2005 

COD18b2 Abruptio placenta Y Abruptio box checked 

 N Abruptio box not checked 

COD18b3 Placental insufficiency Y Placental box checked 

 N Placental box not checked 

COD18b4 Prolapsed cord Y Cord box checked 

 N Cord box not checked

COD18b5 Chorioamnionitis Y Chorio box checked 

 N Chorio box not checked

COD18b6 Other complications of placenta, cord, Y Other box checked 

 Or membranes N Other box not checked 

COD18b7 Unknown Y Unknown box checked 

 N Unknown box not checked

COD18b8 Maternal conditions/diseases literal Literal responses 

COD18b9 Other complications of placenta, cord, or Literal responses 

 Membranes literal 

COD18b10 Other obstetrical or pregnancy complications Literal responses 

 literal 

COD18b11 Fetal anomaly literal Literal responses 

COD18b12 Fetal injury literal Literal responses 

COD18b13 Fetal infection literal Literal responses 

COD18b14 Other fetal conditions/disorders literal Literal responses 

EDITS: 

Before the record is transmitted to the State 

ELECTRONIC RECORD 

The electronic fetal death report can be made more useful by providing some more immediate edit checks based on 

literal entries. Below are some specifications. 
Item 18a,18b, page 14 

5/2004; Updated 2/18/2005 

1) Unacceptable causes. An edit that flags the following as unacceptable causes if they are the only cause reported or 

are reported on the lowest line of the certification: asystole, cardiac arrest, CAR, cardiac pul arrest, cardiac 

pulmonary arrest, cardiopulmonary arrest, CPAR, ventricular fibrillation, VF, electrical mechanical dissociation, 

EMD, and electromechanical dissociation. 

The edit message should be: Mechanistic terminal events such as the last entry preferably should not be either 

the initiating cause in a cause-of-death statement. Please enter the medical conditions that led to this terminal 

event. 

2) Spellcheck. Include an automatic spelling checker 

3) Abbreviations and parentheses. If there is an abbreviation or parentheses in the cause-of-death statement, provide 

a message that neither is good practice and please specify what is meant. It would be desirable to customize 

abbreviations so that the computer would ask if the certifier meant x,y, or specify. Providing possible terms using the 

same abbreviations would a) illustrate why using abbreviations is confusing and b) lessen the work the certifier needs 

to do to correct the entry. The abbreviations, shown below, are from NCHS Instruction Manual Part 2b, Instructions 

for Classifying Multiple Causes of Death, 2000. 

The edit message should be: Please do not use abbreviations to report cause of death. We think that the full term 

for (e.g., AAA) is (e.g., abdominal aortic aneurysm)? Indicate which term is correct if multiple meanings are 

possible, or specify what you meant by the abbreviation if we have not suggested the correct full term. Thank you.

AAA abdominal aortic aneurysm 

AAS aortic arch syndrome 

AAT alpha-antitrypsin 

AAV AIDS-associated virus 

AB abortion; asthmatic 

 bronchitis 

ABD abdomen 

ABE acute bacterial endocarditis 

ABS acute brain syndrome 

ACA adenocarcinoma 

ACD arteriosclerotic coronary 

 disease; absolute 

 cardiac dullness 

ACH adrenal cortical hormone 

ACT acute coronary thrombosis 

ACTH adrenocorticotrophic 

 hormone 

ACVD arteriosclerotic 

 cardiovascular disease 

AD auris dextra (right ear); 

 addiction, drug; adenoidal 

 degeneration; atrio dextro 

 (rt. atrium) 

ADEM acute disseminated 

 encephalomyelitis 

ADH antidiuretic hormone 

ADS antibody deficiency 

 syndrome 

AEG air encephalogram 

AF auricular or atrial 

 fibrillation; acid fast 

AFB acid-fast bacillus 

AFI amaurotic familial idiocy 

AGG agammaglobulinemia 

AGL acute granulocytic leukemia 

AGN acute glomerulonephritis 

AGS adrenogenital syndrome 

AHA acquired hemolytic anemia; 

 autoimmune hemolytic 

anemia 

AHD arteriosclerotic heart disease 
Item 18a,18b, page 15 

5/2004; Updated 2/18/2005 

AHHD arteriosclerotic 

 hypertensive heart disease 

AHG anti-hemophilic globulin 

 deficiency 

AHLE acute hemorrhagic 

leukoencephalitis 

AI aortic insufficiency; 

 additional information 

AIDS acquired immunodeficiency 

syndrome 

AKA above knee amputation 

ALL acute lymphocytic leukemia 

ALS amyotrophic lateral sclerosis 

AMI acute myocardial infarction 

AML acute myelocytic leukemia 

ANS arteriolonephrosclerosis 

AOD arterial occlusive disease 

AODM adult onset diabetes 

 mellitus 

AOM acute otitis media 

AP angina pectoris; anterior 

 and posterior repair; 

 artificial pneumothorax; 

 anterior pituitary 

A&P anterior and posterior repair 

APC auricular premature 

 contraction; Acetylsalicylic 

 acid, Acetophenetidin, and 

 caffeine 

APE acute pulmonary edema; 

 anterior pituitary extract 

APH antepartum hemorrhage 

AR aortic regurgitation 

ARC AIDS-related complex 

ARF acute respiratory failure 

ARM artificial rupture of 

 membranes 

ARV AIDS-related virus 

AS arteriosclerotic; 

 arteriosclerosis; 

 aortic stenosis; auris 

 sinestra (left ear) 

ASA acetylsalicylic acid (aspirin) 

ASAD arteriosclerotic artery 

 disease 

ASCD arteriosclerotic coronary 

 disease 

ASCHD arteriosclerotic coronary 

 heart disease 

ASCVA arteriosclerotic 

 cerEBRovascular accident 

ASCVD arteriosclerotic 

 cardiovascular disease 

ASCVHD arteriosclerotic 

 cardiovascular heart 

 disease 

ASCVRD arteriosclerotic 

 cardiovascular renal 

 disease 

ASD atrial septal defect 

ASDHD arteriosclerotic 

 decompensated heart 

 disease 

ASHCVD arteriosclerotic 

 hypertensive 

 cardiovascular disease 

ASHD arteriosclerotic heart 

 disease; atrioseptal heart 

 defect 

ASHHD arteriosclerotic 

 hypertensive heart disease 

ASHVD arteriosclerotic 

 hypertensive vascular 

 disease 

ASO arteriosclerosis obilterans 

ASPVD arteriosclerotic peripheral 

 vascular disease 

ASVD arteriosclerotic vascular 

 disease 

ASVH(D) arteriosclerotic vascular 

 heart disease 

ATC all-terrain cycle 

ATN acute tubular necrosis 

ATS anxiety tension state; 

 anti-tetanus serum; 

 arteriosclerosis 

ATSHD arteriosclerotic heart 

 disease 

ATV all-terrain vehicle 

AU aures unitas (both ears) 

AUL acute undifferentiated 

 leukemia 

AV arteriovenous; 

 auriculoventricular; aortic 

 valve 

AVF arterio-ventricular fibrillation; 

 arteriovenous fistula 

AVH acute viral hepatitis 

AVP aortic valve prosthesis 

AVR aortic valve replacement 

AWMI anterior wall myocardial 

 infarction 

AZT azidothymidine 

BA basilar arteriogram; bronchial 

 asthma; basilar artery 

B&B bronchoscopy and biopsy 

BBB bundle branch block 

B&C biopsy and cauterization 

BCE basal cell epithelioma 

BE barium enema 

BEH benign essential hypertension 

BGL Bartholin's gland 

BKA below knee amputation 

BL bladder; bucolingual; blood loss; 

 Burkitt’s lymphoma 

BMR basal metabolism rate 

BNA Bladder neck adhesions 

BNO bladder neck obstruction 

BOMSA bilateral otitis media serous 

 acute 

BOMSC bilateral otitis media 

 serous chronic 

BOW "bag of water" (membrane) 

B/P, BP blood pressure 

BPH benign prostate hypertrophy 

BSA body surface area 

BSO bilateral 

 salpingo-oophorectomy 

BSP Bromosulfaphthalein test 

BTL bilateral tubal ligation 

BUN blood, urea, and nitrogen test 

BVL bilateral vas ligation 

B&W Baldy-Webster suspension 

 (uterine) 

BX biopsy 

BX CX biopsy cervix 

_ 

c with 

Ca cancer 

CA cancer; carotid arteriogram; 

 cardiac arrest 

CAD coronary artery disease 

CAG chronic atrophic gastritis 

CAO coronary artery occlusion; 

 chronic airway obstruction 

CAS cerEBRal arteriosclerosis 

CASCVD chronic arteriosclerotic 

 cardio-vascular disease 

CB chronic bronchitis 

CBC complete blood count 

CBD common bile duct 

CBS chronic brain syndrome 

CCF chronic congestive failure 

CCI chronic cardiac or coronary 

 insufficiency 

CDE common duct exploration 

CDH congenital dislocation hip 

CF congestive failure; 

 compliment fixation test; 

 cystic fibrosis; Christmas 

 factor (plasma 

 thromboplastin component) 

CFT chronic follicular tonsillitis 

CGN chronic glomerulonephritis 

CHA congenital hypoplastic 

 anemia 

CHB complete heart block 

CHD congestive heart disease; 

 coronary heart disease; 

 Chediak-Higaski Disease; 

 congenital heart disease 

CHF congestive heart failure 

C2H5OH ethyl alcohol 

CI cardiac insufficiency; 

 cerEBRal infarction 

CID cytomegalic inclusion 

 disease 
Item 18a,18b, page 16 

5/2004; Updated 2/18/2005 

CIS carcinoma in situ 

CLD chronic lung disease; 

 chronic liver disease 

CLL chronic lymphatic 

 leukemia; chronic 

 lymphocytic leukemia 

CMID cytomegalic inclusion 

 disease 

CML chronic myelocytic leukemia 

CMM cutaneous malignant 

 melanoma 

CMV cytomegalic virus 

CNHD congenital nonspherocytic 

 hemolytic disease 

CNS central nervous system 

CO carbon monoxide 

COAD chronic obstructive airway 

 disease 

CO2 carbon dioxide 

COBE chronic obstructive bullous 

 emphysema 

COBS chronic organic brain 

 syndrome 

COFS cerEBRo-oculo-facioskeletal 

COOMBS test for Rh sensitivity 

COLD chronic obstructive lung 

 disease 

COPD chronic obstructive 

 pulmonary disease 

COPE chronic obstructive 

 pulmonary emphysema 

CP cerEBRal palsy; cor pulmonale 

C&P cystoscopy and pyelography 

CPB cardiopulmonary bypass 

CPC chronic passive congestion 

CPD cephalopelvic disproportion; 

 contagious pustular dermatitis 

CPE chronic pulmonary 

 emphysema 

CRD chronic renal disease 

CRF cardiorespiratory failure; 

 chronic renal failure 

CRST calcinosis cutis, Raynaud's 

 phenomenon, sclerodactyly, 

 and telangiectasis 

CS coronary sclerosis; cesarean 

 section; cerEBRo-spinal 

CSF cerEBRal spinal fluid 

CSH chronic subdural hematoma 

CSM cerEBRospinal meningitis 

CT cerEBRal thrombosis; 

coronary 

 thrombosis 

CTD congenital thymic dysplasia 

CU cause unknown 

CUC chronic ulcerative colitis 

CUP cystoscopy, urogram, 

 pyelogram (retro) 

CUR cystocele, urethrocele, 

 rectocele 

CV cardiovascular; 

 cerEBRovascular 

CVA cerEBRal vascular accident 

CV Accident cerEBRal vascular 

 accident 

CVD cardiovascular disease 

CVHD cardiovascular heart disease 

CVI cardiovascular insufficiency; 

 cerEBRal vascular 

 insufficiency 

CVRD cardiovascular renal disease 

CWP coal worker's 

 pneumoconiosis 

CX cervix 

DA degenerative arthritis 

DBI Phenformin hydrochloride 

D&C dilation and curettage 

DCR dacrocystorhinostomy 

D&D drilling and drainage; 

 dEBRidement and dressing 

D&E dilation and evacuation 

DFU dead fetus in utero 

DIC disseminated intravascular 

 coagulation 

DILD diffuse infiltrative lung 

 disease 

DIP distal interphalangeal joint; 

 desquamative interstitial 

 pneumonia 

DJD degenerative joint disease 

DM diabetes mellitus 

DMT dimethyltriptamine 

DOA dead on arrival 

DOPS diffuse obstructive 

 pulmonary syndrome 

DPT diphtheria, pertussis, 

 tetanus vaccine 

DR diabetic retinopathy 

DS Down's syndrome 

DT due to; delirium tremens 

D/T delirium tremens; due to 

DU diagnosis unknown; 

 duodenal ulcer 

DUB dysfunctional uterine 

 bleeding 

DUI driving under influence 

DVT deep vein thrombosis 

DWI driving while intoxicated 

DX dislocation; diagnosis; 

 disease 

EBV Epstein-Barr virus 

ECCE extracapsular cataract 

 extraction 

ECG electrocardiogram 

ECT electric convulsive therapy 

EFDR expected date of 

 confinement 

EEE Eastern equine encephalitis 

EEG electroencephalogram 

EFE endocardial fibroelastosis 

EGL eosinophilic granuloma of 

 lung 

EH enlarged heart; essential 

 hypertension 

EIOA excessive intake of alcohol 

EKC epidemic 

 keratoconjunctivitis 

EKG electrocardiogram 

EKP epikeratoprosthesis 

ELF elective low forceps 

EMC encephalomyocarditis 

EMD electromechanical 

 dissociation 

EMF endomyocardial fibrosis 

EMG electromyogram 

EN erythema nodosum 

ENT ear, nose, and throat 

EP ectopic pregnancy 

ER emergency room 

ERS evacuation of retained 

 secundines 

EST electric shock therapy 

ETOH alcohol 

EUA exam under anesthesia 

EWB estrogen withdrawal 

 bleeding 

FB foreign body 

FBS fasting blood sugar 

Fe symbol for iron 

FGD fatal granulomatous disease 

FHS fetal heart sounds 

FHT fetal heart tone 

FLSA follicular lymphosarcoma 

FME full-mouth extraction 

FS frozen section; fracture site 

FT full term 

FTA fluorescent Treponemal 

 antibody test 

5FU Fluorouracil 

FUB functional uterine bleeding 

FULG fulguration 

FUO fever unknown origin 

FX fracture 

FYI for your information 

GAS generalized arteriosclerosis 

GB gallbladder; Guillain-Barre 

 syndrome 

GC gonococcus; gonorrhea; 

 general circulation (systemic) 

GI gastrointestinal 

GIT gastrointestinal tract 

GOK God only knows 

GSW gunshot wound 

GTT glucose tolerance test 

gtt drop 
Item 18a,18b, page 17 

5/2004; Updated 2/18/2005 

GU genitourinary; gastric ulcer 

GVHR graft versus host reaction 

GYN gynecology 

HA headache 

HAA hepatitis associated antigen 

HASCVR hypertensive 

 arteriosclerotic 

 cardiovascular renal 

 disease 

HASVD hypertensive 

 arteriosclerotic vascular 

 disease 

HB hemoglobin; heart block 

HBP high blood pressure 

HC Huntington's chorea 

HCT hematocrit 

HCVD hypertensive cardiovascular 

 disease 

HCVRD hypertensive cardiovascular 

 renal disease 

HD Hodgkin's disease; heart 

 disease 

HDN hemolytic disease of newborn 

HDS herniated disc syndrome 

HF heart failure; hayfever 

HGB;Hgb hemoglobin 

HHD hypertensive heart disease 

HIV human immunodeficiency 

 virus 

HMD hyaline membrane disease 

HN2 Nitrogen Mustard 

HNP herniated nucleus pulposus 

H/O history of 

HPN hypertension 

HPVD hypertensive pulmonary 

 vascular disease 

HRE high-resolution 

 electro-cardiology 

HS herpes simplex; Hurler's 

 syndrome 

HTLV-III/LAV human T-cell 

 lymphotropic 

 virus-III/ 

 lymphadenopathy- 

 associated virus 

HTLV-3 human T-cell 

 lymphotropic virus-III 

HTLV-III human T-cell 

 lymphotropic virus -III 

HVD hypertensive vascular 

 disease 

Hx history of 

IADH inappropriate antidiuretic 

 hormone 

IASD interatrial septal defect 

ICCE intracapsular cataract 

 extraction 

ICD intrauterine contraceptive 

 device 

I&D infectious disease; incision 

 and drainage 

IDA iron deficiency anemia 

IDDM type 1 diabetes 

IH infectious hepatitis 

IHD ischemic heart disease 

IHSS idiopathic hypertrophic 

 subaortic stenosis 

ILD ischemic leg disease 

IM intramuscular; 

 intramedullary; infectious 

 mononucleosis 

IMPP intermittent positive pressure 

INAD infantile neuroaxonal 

 dystrophy 

INC incomplete 

INE infantile necrotizing 

 encephalomylopathy 

INF infection; infected; infantile; 

infarction 

INH Isoniazid; inhalation 

INS idiopathic nephrotic 

 syndrome 

IO intestinal obstruction 

IOH idiopathic orthostatic 

 hypotension 

IPD inflammatory pelvic disease 

IPP intermittent positive pressure 

IRDS idiopathic respiratory distress 

 syndrome 

IRHD inactive rheumatic heart 

 disease 

ISD interatrial septal defect 

ITP idiopathic thrombocytopenic 

 purpura 

IU intrauterine 

IUCD intrauterine contraceptive 

 Device 

IUD intrauterine device 

 (contraceptive); intrauterine 

 death 

IUP intrauterine pregnancy 

IVC intravenous cholangiography; 

 inferior vena cava 

IVCC intravascular consumption 

 coagulopathy 

IVD intervertEBRal disc 

IVH intraventricular hemorrhage 

IVP intravenous pyelogram 

IVSD intraventricular septal defect 

IVU intravenous urethrography 

IWMI inferior wall myocardial 

 infarction 

JBE Japanese B encephalitis 

KFS Klippel-Feil syndrome 

KS Klinefelter's syndrome 

KUB kidney, ureter, bladder 

K-W Kimmelstiel-Wilson disease 

 or syndrome 

LAP laparotomy 

LAV lymphadenopathy-associated 

 virus 

LAV/ lymphadenopathy- 

 associated 

HTLV-III virus/Human T-cell 

 lymphotrophic virus-III 

LBBB left bundle branch block 

LBNA lysis bladder neck 

 adhesions 

LBW low birth weight 

LBWI low birth weight infant 

LCA left coronary artery 

LDH lactic dehydrogenase 

LE lupus erythematosus; lower 

 extremity; left eye 

LKS liver, kidney, spleen 

LLL left lower lobe 

LMA left mentoanterior (position 

 of fetus) 

LMCAT left middle cerEBRal 

artery 

 thrombosis 

LML left mesiolateral; left 

 mediolateral (episiotomy) 

LMP last menstrual period; left 

 mento-posterior (position of 

 fetus) 

LN lupus nephritis 

LOA left occipitoanterior 

LOMCS left otitis media chronic 

 serous 

LP lumbar puncture 

LRI lower respiratory infection 

LS lumbosacral;lymphosarcoma 

LSD lysergic acid diethylamide 

LSK liver, spleen, kidney 

LSO left salpingo-oophorectomy 

LTB laryngotracheobronchitis 

LUL left upper lobe 

LVF left ventricular failure 

LVH left ventricular hypertrophy 

MBD minimal brain damage 

MD muscular dystrophy; manic 

 depressive; myocardial 

 damage 

MDA methylene 

 dioxyamphetamine 

MEA multiple endocrine 

 adenomatosis 

MF myocardial failure; 

 myocardial fibrosis; mycosis 

 fungoides 

MGN membranous 

 Glomerulonephritis 

MHN massive hepatic necrosis 
Item 18a,18b, page 18 

5/2004; Updated 2/18/2005 

MI myocardial infarction; mitral 

 insufficiency 

MID multi-infarct dementia 

MLC myelomonocytic leukemia, 

 chronic 

MM malignant melanoma; 

 multiple myeloma 

MMOA mandible, maxillary, 

 odontectomy, 

 alveolectomy 

MOD mode of death; moment of 

 death 

MPC meperidine, promethazine, 

 chlorpromazine 

MS multiple sclerosis; mitral 

 stenosis 

MT malignant teratoma 

MUA myelogram 

MVR mitral valve regurgitation 

NACD no anatomical cause of 

 death 

NCA neurocirculatory asthenia 

NDI nephrogenic diabetes 

 insipidus 

NFI no further information 

NFTD normal full-term delivery 

NH3 symbol for ammonia 

NIDDM type 2 diabetes 

NMI no more information 

NPD Niemann-Pick disease 

NSD normal spontaneous 

 delivery; nonsurgical 

 delivery 

NSR normal sinus rhythm; nasal 

 submucous resection 

NTG nontoxic goiter 

NTN nephrotoxic nephritis 

N&V nausea and vomiting 

NVD nausea, vomiting, diarrhea 

OA osteoarthritis 

OAD obstructive airway disease 

OB obstetrical 

OBS organic brain syndrome 

OBST obstetrical 

OD oculus dexter (right eye); 

overdose; occupational 

 disease 

OHD organic heart disease 

OM otitis media 

OMI old myocardial infarction 

OMS organic mental syndrome 

ORIF open reduction, internal 

 fixation 

OS oculus sinister (left eye); 

 occipitosacral (fetal 

 position) 

OT occupational therapy; old 

 TB 

OU oculus uterque (each eye); 

 both eyes 

PA pericious anemia; paralysis 

 agitans; pulmonary artery; 

 peripheral arterio sclerosis 

PAC premature auricular 

 contraction; phenacetin, 

 aspirin, caffeine 

PAF paroxysmal auricular 

 fibrillation 

PAOD peripheral arterial occlusive 

 disease; peripheral 

 arteriosclerosis occlusive 

 disease 

PAP primary atypical pneumonia 

PAS pulmonary artery stenosis 

PAT pregnancy at term; 

 paroxysmal auricular 

 tachycardia 

Pb chemical symbol for lead 

PCD polycystic disease 

PCF passive congestive failure 

PCP pentachlorophenol; 

 pneumocystis carinii 

 pneumonia 

PCT porphyria cutanea tarda 

PCV polycythemia vera 

PDA patent ductus arteriosus 

PE pulmonary embolism; pleural 

 effusion; pulmonary edema 

PEG pneumoencephalography 

PET pre-eclamptic toxemia 

PG pregnant; prostaglandin 

PGH pituitary growth hormone 

PH past history; prostatic 

 hyertrophy; pulmonary 

 hypertension 

PI pulmonary infarction 

PID pelvic inflammatory disease; 

 pro-lapsed intervertEBRal disc 

PIE pulmonary interstitial 

 emphysema 

PIP proximal interphalangeal joint 

PKU phenylketonuria 

PMD progressive muscular 

 dystrophy 

PMI posterior myocardial 

 infarction; point of maximum 

 impulse 

PN periarteritis nodosa; 

 pneumonia;pyelonephritis 

PO postoperative 

POC product of conception 

POE point (or portal) of entry 

PP postpartum 

PPD purified protein derivative test 

 for tuberculosis 

PPH postpartum hemorrhage 

PPLO pleuropneumonia-like 

 organism 

PPS postpump syndrome 

PPT precipitated; prolonged 

 prothrombin time 

PROM premature rupture of 

 membranes 

PT paroxysmal tachycardia; 

 pneumothorax; prothrombin 

 time 

PTA prior to admission; persistent 

 truncus arteriosus 

PTC plasma thromboplastin 

 component 

PU peptic ulcer 

PUD peptic ulcer disease; 

 pulmonary disease 

PUO pyrexia of unknown origin 

P&V pyloroplasty and vagotomy 

PVC premature ventricular 

 contraction 

PVD peripheral vascular disease; 

 pulmonary vascular disease 

PVI peripheral vascular 

 insufficiency 

PVT paroxysmal ventricular 

 tachycardia 

PVS premature ventricular systole 

 (contraction) 

PWI posterior wall infarction 

PWMI posterior wall myocardial 

 infarction 

PX pneumothorax 

R right 

RA rheumatoid arthritis; right 

 atrium; right auricle 

RAD radiation absorbed dose 

RAI radioactive iodine 

RBBB right bundle branch block 

RBC red blood cells 

RCA right coronary artery 

RCS reticulum cell sarcoma 

RD Raynaud's disease; respiratory 

 disease 

RDS respiratory distress syndrome 

RE regional enteritis 

REG radioencephalogram 

RF rheumatic fever 

RHD rheumatic heart disease 

RLF retrolental fibroplasia 

RLL right lower lobe 

RMCA right middle cerEBRal 

artery 

RMCAT right middle cerEBRal 

artery 

 thrombosis 

RMLE right mediolateral 

 episiotomy 

RNA ribonucleic acid 

RND radical neck dissection 
Item 18a,18b, page 19 

5/2004; Updated 2/18/2005 

R/O rule out 

RSA reticulum cell sarcoma 

RSR regular sinus rhythm 

Rt right 

RT recreational therapy; right 

RTA renal tubular acidosis 

RV right ventricle 

RVH right ventricular hypertrophy 

RVT renal vein thrombosis 

RX drugs or other therapy or 

 treatment 

þ without 

SA sarcoma; secondary anemia 

SACD subacute combined 

 degeneration 

SBE subacute bacterial 

 endocarditis 

SBO small bowel obstruction 

SC sickle cell 

SCC squamous cell carcinoma 

SCI Subcoma insulin; spinal cord 

 injury 

SD spontaneous delivery; septal 

defect; sudden death 

SDAT senile dementia, Alzheimer's 

 type 

SDII sudden death in infancy 

SDS sudden death syndrome 

SF scarlet fever 

SGA small for gestational age 

SH serum hepatitis 

SI saline injection 

SIADH syndrome of inappropriate 

 antidiuretic hormone 

SICD sudden infant crib death 

SID sudden infant death 

SIDS sudden infant death syndrome 

SLC short leg cast 

SLE systemic lupus erythematosus; 

 Saint Louis encephalitis 

SMR submucous resection 

SNB scalene node biopsy 

SO or S&O salpingo-oophorectomy 

SOB shortness of breath 

SOM secretory otitis media 

SOR suppurative otitis, recurrent 

S/P status post 

SPD sociopathic personality 

 disturbance 

SPP suprapubic prostatectomy 

SQ subcutaneous 

S/R schizophrenic reaction; 

 sinus rhythm 

S/p P/T schizophrenic reaction, 

 paranoid type 

SSE soapsuds enema 

SSKI saturated solution 

 potassium iodide 

SSPE subacute sclerosing 

 panencephalitis 

STB stillborn 

STS serological test for syphilis 

STSG split thickness skin graft 

SUBQ subcutaneous 

SUD sudden unexpected death 

SUDI sudden unexplained death 

 of an infant 

SUID sudden unexpected infant 

 death 

SVC superior vena cava 

SVD spontaneous vaginal 

 delivery 

Sx symptoms 

T&A tonsillectomy and 

 adenoidectomy 

TAH total abdominal 

 hysterectomy 

TAL tendon achilles 

 lengthening 

TAO Triacetyloleandomycin 

 (antibiotic); thromboangiitis 

 oliterans 

TAPVR total anomalous pulmonary 

 venous return 

TAR thrombocytopenia absent 

 radius (syndrome) 

TAT tetanus anti-toxin 

TB tuberculosis; 

 tracheobronchitis 

TBC,Tbc tuberculosis 

TBLC term birth living child 

TCI transient cerEBRal 

 ischemia 

TEF tracheo-esophageal fistula 

TF tetralogy of Fallot 

TGV transposition great vessels 

TI tricuspid insufficiency 

TIA transient ischemic attack 

TIE transient ischemic episode 

TL tubal ligation 

TM tympanic membrane 

TOA tubo-ovarian abscess 

TP thrombocytopenic purpura 

TSD Tay-Sachs disease 

TTP thrombotic 

 thrombocytopenic purpura 

TUI transurethral incision 

TUR transurethral resection 

 (NOS) (prostate) 

TURP transurethral resection of 

 prostate 

TVP total anomalous venous 

 return 

UC ulcerative colitis 

UP ureteropelvic 

UPJ ureteropelvic junction 

URI upper respiratory infection 

UTI urinary tract infection 

VAMP vincristine, amethopterine, 

 6-mercaptopurine, and 

 prednisone 

VB vinblastine 

VC vincristine 

VD venereal disease 

VDRL venereal disease research lab 

VEE Venezuelan equine 

 encephalomyelitis 

VF ventricular fibrillation 

VH vaginal hysterectomy; viral 

 hepatitis 

VL vas ligation 

VM viomycin 

V&P vagotomy and pyloroplasty 

VPC ventricular premature 

 contractions 

VR valve replacement 

VSD ventricular septal defect 

VT ventricular tachycardia 

WBC white blood cell 

WC whooping cough 

WE Western encephalomyelitis 

WPW Wolfe-Parkinson-White 

 syndrome 

YF yellow fever 

ZE Zollinger-Ellison (syndrome) 

# fracture 

' minute 

" second(s) 

9 decreased 

8 increased; elevated 

ÿ without 

00

11 secondary to 

00

11 to secondary to 
Item 18a,18b, page 20 

5/2004; Updated 2/18/2005 

4) Rare cause. If a rare cause of death is on the fetal death report, provide an automatic query stating: The 

reported cause is one of the causes that State Health Departments always try to verify, either because the 

cause is rarely reported on a fetal death report or because it may present threats to public health in the 

United States. Then ask, Was this the cause of death that the certifier intended to enter? 

 The diagnosis then needs to be confirmed by the certifier. It is strongly recommended by NCHS/CDC that the State 

vital statistics program notify, as soon as possible, the state health officer (or designee) and the state epidemiologist 

of validated rare causes of death. For all cases, a notation of confirmation should be recorded on a copy of the 

certificate that is sent to the NCHS, whether confirmed electronically or by traditional means. Correspondence 

between NCHS and the State will still be needed, so that we ensure that all appropriate parties are aware that a 

rare cause has been reported. 

The following list of infrequent and rare causes is derived from NCHS Instruction Manual Part 2a, Instructions for 

classifying the underlying cause of death, 2001 (will be updated in the 2002 manual): 

A00 Cholera 

A01 Typhoid and paratyphoid fevers 

A05.1 Botulism (botulism, infant botulism, wound botulism) 

A20 Plague 

A21 Tularemia 

A22 Anthrax 

A23 Brucellosis 

A24.0 Glanders 

A24.1-.4 Melioidosis 

A25 Rat-bite fever 

A27 Leptospirosis 

A30 Leprosy 

A36 Diphtheria 

A37 Whooping cough 

A44 Bartonellosis 

A65 Nonvenereal syphyllis 

A66 Yaws 

A67 Pinta 

A68 Relapsing fever 

A69 Other spirochetal infection 

A70 Chlamydia psittaci infection (ornithosis) 

A75.0 Louse-born typhus due to Rickettsia prowazekii 

A75.1-.9 Other typhus 

A77.1 Spotted fever due to Rickettsia conorii (Boutonneuse fever) 
Item 18a,18b, page 21 

5/2004; Updated 2/18/2005 

A77.2 Spotted fever due to Rickettsia siberica (North Asian tick fever) 

A77.3 Spotted fever due to Rickettsia australis (Queensland tick typhus) 

A77.8 Other spotted fevers (Other tick-born rickettsioses) 

A77.9 Unspecified spotted fevers (Unspecified tick-born rickettsioses) 

A78 Q fever 

A79 Other Rickettsioses 

A80 Acute poliomyelitis 

A81 Slow virus infections of central nervous system 

A82 Rabies 

A84 Tick-born viral encephalitis 

A85.2 Arthropod-born viral encephalitis, unspecified (Viral encephalitis transmitted by other and 

unspecified arthropods) 

A90 Dengue fever 

A91 Dengue hemmorrhagic fever 

A92 Other mosquito-born viral fevers 

A93 Other arthropod-born viral fevers including Oropouche 

 fever, sandfly fever, Colorado tick fever and other specified 

A94 Unspecified arthropod-born viral fever 

A95 Yellow fever 

A96 Arenaviral hemorrhagic fever 

A98-A99 Other viral hemorrhagic fevers including Crimean-Congo, 

 Omsk, Kyasanur Forest, Ebola virus, Hanta virus 

B01 Varicella without complication (Chickenpox) 

B03 Small pox 

B04 Monkeypox 

B05 Measles 

B08.0 Other orthopoxvirus (cowpox and paravaccinia) 

B26 Mumps 

B33.0 Epidemic myalgia (epidemic pleurodynia) 

B50-B54 Malaria 

B55 Leishmaniasis 

B56 African trypanosomiasis (trypanosomiasis) 

B57 Chagas' disease (trypanosomiasis) 

B65 Schistosomiasis 

B66 Other fluke infections (Other trematode infection) 

B67 Echinococcosis 

B68 Taeniasis 

B69 Cysticercosis 

B70 Diphyllobothriasis and sparganosis 

B71 Other cestode infections 

B72 Dracunculiasis (Dracontiasis) 

B73 Onchocerciasis 

B74 Filariasis (Filarial infection) 

P35.0 Congenital rubella syndrome 

W88-W91 Exposure to radiation 

Y36.5 War operation involving nuclear weapons 
Item 18a,18b, page 22 

5/2004; Updated 2/18/2005 

5) Specificity for cancer. If words indicative of cancer appear on the fetal death report (as shown below), 

ask Have you specified the site and cell type or if the condition had metastasized? Thank you. The 

following list is from Instruction manual part 2g, Data Entry Instructions for the Mortality Medical 

Indexing, Classification, and Retrieval System (MICAR), 2000.

Acidophil cancer 

Acidophil carcinoma 

Adenocarcinoma 

Adenocarcinomatosis 

Adenofibroma 

Adenoid cystic carcinoma 

Adenoma 

Adenomatous polyp 

Adenomatous polyposis 

Adenosarcoma 

Adenosquamous (cell) cancer 

Adenosquamous (cell) carcinoma 

Aleukemic leukemia 

Alveolar adenocarcinoma 

Alveolar carcinoma 

Alveolar cancer 

Alveolar cell cancer 

Alveolar cell carcinoma 

Alveolar rhabdomyosarcoma 

Anaplastic adenocarcinoma 

Anaplastic astrocytoma 

Anaplastic cancer 

Anaplastic carcinoma 

Anaplastic fulminant cancer 

Anaplastic fulminant carcinoma 

Angioblastic meningioma 

Angioblastoma 

Angioma 

Angiomyosarcoma 

Angiosarcoma 

Apocrine cancer 

Apocrine carcinoma 

Astroblastoma 

Astrocytoma 

Astroglioma 

Basal cell cancer 

Basal cell carcinoma 

Basal cell epithelioma 

Basophil adenocarcinoma 

Basophil cancer 

Basophil carcinoma 

Bile duct type cancer 

Bile duct type carcinoma 

C cell cancer 

C cell carcinoma 

Cancer 

Carcinoid 

Carcinoid malignancy 

Carcinoid tumor 

Carcinoma 

Carcinomatosis 

Cavernous hemangioma 

Cavernous lymphangioma 

Chemodectoma 

Cholangiocarcinoma 

Cholangiohepatoma 

Cholangioma 

Chondrosarcoma 

Chordoma 

Choriocarcinoma 

Chorioepithelioma 

Chorionic cancer 

Chorionic carcinoma 

Chromophobe adenocarcinoma 

Chromophobe adenoma 

Chromophobe cancer 

Chromophobe carcinoma 

Clear cell adenocarcinoma 

Congenital leukemia 

Craniopharyngioma 

Cylindroma 

Cystadenocarcinoma 

Dermatofibroma 

Dermatofibrosarcoma 

Di Guglielmos disease 

Duct cell carcinoma 

Ductal cancer 

Ductal carcinoma 

Ductal cell carcinoma 

Dukes adenocarcinoma 

Dukes cancer 

Dysgerminoma 

Eaton lambert syndrome 

Embryoma 

Embryonal adenocarcinoma 

Embryonal cancer 

Embryonal carcinoma 

Eosinophil adenocarcinoma 

Eosinophil cancer 

Eosinophil carcinoma 

Ependymoblastoma 

Ependymoma 

Epidermoid cancer 

Epidermoid carcinoma 

Epidermoid cystic tumor 

Epithelioma 

Erythremic myelosis 

Erythrocythemia 

Erythroleukemia 

Ewings sarcoma 

Ewings tumor 

Familial polyposis 

Fibroid 

Fibroid tumor 

Fibrolipoma 

Fibroliposarcoma 

Fibroma 

Fibromyoma 

Fibromyosarcoma 

Fibromyxolipoma 

Fibromyxosarcoma 

Fibrosarcoma 

Fibrous histiocytoma 

Follicular adenocarcinoma 

Follicular lymphoma 

Ganglioglioma 

Gardners syndrome 

Gastrinoma 

Gastrocarcinoma 

Germ cell carcinoma 

Giant cell cancer 

Giant cell carcinoma 

Giant cell leukemia 

Glioblastoma 

Glioblastoma multiforme 

Glioma 

Gliosarcoma 

Glomangioma 

Granulocytic leukemia 

Granulocytic leukemia blast crisis 

Granulosa cell cancer 

Granulosa cell carcinoma 

Growth 

Hemangioendothelioma 

Hemangioma 

Hemangiopericytoma 

Hemangiosarcoma 

Hemoleukemia 
Item 18a,18b, page 23 

5/2004; Updated 2/18/2005 

Hepatoblastoma 

Hepatocarcinoma 

Hepatocellular cancer 

Hepatocellular carcinoma 

Hepatocholangiocarcinoma 

Hepatocholangiolitic cancer 

Hepatocholangiolitic carcinoma 

Hepatoma 

Histiocytic leukemia 

Histiocytic lymphoma 

Histiocytoma 

Hodgkins disease 

Hodgkins disease 

Hodgkins lymphoma 

Hurthle cell adenocarcinoma 

Hurthle cell adenoma 

Hurthle cell cancer 

Hurthle cell carcinoma 

Hygroma 

Hypernephroma 

Immunoblastic sarcoma 

Immunolymphosarcoma 

Infiltrating duct adenocarcinoma 

Infiltrating duct cancer 

Infiltrating duct carcinoma 

Infiltrating duct cell cancer 

Infiltrating duct cell carcinoma 

Infiltrating ductal carcinoma 

Infiltrating lobular carcinoma 

Inflammatory cancer 

Inflammatory carcinoma 

Insulinoma 

Insuloma 

Intraductal cancer 

Intraductal carcinoma 

Islet cell adenocarcinoma 

Islet cell adenoma 

Islet cell cancer 

Islet cell carcinoma 

Kaposi sarcoma 

Kaposis sarcoma 

Kasabach Merritt syndrome 

Krukenbergs tumor 

Large cell anaplastic cancer 

Large cell anaplastic carcinoma 

Large cell cancer 

Large cell carcinoma 

Large cell lymphoma 

Large cell tumor 

Leiomyosarcoma 

Lesion 

Leucosarcoma 

Leukemia 

Leukemic crisis 

Leukemic infiltrate 

Leukemic infiltration 

Leukemic lymphosarcoma 

Leukolymphosarcoma 

Leukosarcoma 

Linitis plastica 

Lipoblastoma 

Lipoblastomatosis 

Lipofibroma 

Lipoma 

Lipomyosarcoma 

Lipomyxoma 

Lipomyxosarcoma 

Liposarcoma 

Lobular carcinoma 

Lymphangiosarcoma 

Lymphangiosarcoma 

Lymphatic leukemia 

Lymphocyte depleted 

Lymphocytic leukemia 

Lymphocytic lymphoma 

Lymphocytic lymphosarcoma 

Lymphogenous leukemia 

Lymphohistiocytic lymphoma 

Lymphoid leukemia 

Lympholeukemia 

Lymphoma 

Lymphomatous disease 

Lymphoproliferative disease 

Lymphoproliferative disorder 

Lymphoreticularproliferative disease 

Lymphoreticularproliferative 

 disorder 

Lymphoreticulum cell leukemia 

Lymphosarcoma 

Lymphosarcoma cell leukemia 

Lymphosarcoma leukemia 

Malignancy 

Mass 

Medullary carcinoma 

Medulloblastoma 

Megaadenoma 

Megakaryocytic leukemia 

Megakaryocytic myelosclerosis 

Megakaryocytoid leukemia 

Megaloleukemia 

Meigs syndrome 

Melanoma 

Meningioma 

Mesenchymoma 

Mesoepithelioma 

Mesothelioma 

Metastases 

Metastasis 

Microglioma 

Mixed cell leukemia 

Mixed cell lymphoma 

Mixed leukemia 

Monocytic leukemia 

Monocytoid leukemia 

Monoleukemia 

Monoleukocytic leukemia 

Monomyelocytic leukemia 

Monomyelogenous leukemia 

Mucinous adenocarcinoma 

Mucinous adenofibroma 

Mucinous cancer 

Mucinous carcinoma 

Mucinous cystadenocarcinoma 

Mucinous cystadenocarcoma 

Mucinous cystadenoma 

Mucoepidermoid cancer 

Mucoepidermoid carcinoma 

Mucoid cell adenocarcinoma 

Multiple myeloma 

Myelogenous leukemia 

Myeloid leukemia 

Myeloleukemia 

Myeloma 

Myelomonocytic leukemia 

Myeloproliferative disease 

Myeloproliferative disorder 

Myeloproliferative syndrome 

Myelosis 

Myoliposarcoma 

Myoma 

Myxofibrosarcoma 

Myxoliposarcoma 

Myxopapillary ependymoma 

Myxosarcoma 

Neoplasm 

Neoplastic disease 

Nephroblastoma 

Nephroma 

Neurilemmoma 

Neurilemmosarcoma 

Neuroblastoma 

Neurofibromatosis 

Neurofibrosarcoma 

Neurogenic sarcoma 

Nodular lymphcytic leukemia 

Nodular lymphoma 

Non Hodgkins lymphoma 

Non oat cell carcinoma 

Non small cell carcinoma 

Oat cell cancer 

Oat cell carcinoma 

Oligodendroblastoma 

Oligodendroglioma 

Orchioblastoma 

Osteochondrosarcoma 

Osteofibrosarcoma 

Osteogenic sarcoma 

Osteosarcoma 

Pancoast syndrome 

Pancoast tumor 

Pancoasts syndrome 
Item 18a,18b, page 24 

5/2004; Updated 2/18/2005 

Pancoasts tumor 

Papillary adenocarcinoma 

Papillary cancer 

Papillary carcinoma 

Papillary ependymoma 

Papillary serous adenocarcinoma 

Papillary serous cystadenocarcinoma 

Papillary transitional (cell) 

 carcinoma 

Pheochromoblastoma 

Pheochromocytoma 

Pinealoblastoma 

Pinealoma 

Pineoblastoma 

Pineocytoma 

Plasma cell leukemia 

Plasma cell myeloma 

Plasmacytic myeloma 

Plasmacytoma 

Polycythemia 

Polycythemia rubra vera 

Polycythemia vera 

Polyp 

Polyposis 

Promyelocytic leukemia 

Pseudofollicular leukemia 

Pseudomucinous adenocarcinoma 

Pseudomucinous cancer 

Pseudomucinous carcinoma 

Pseudomucinous 

 cystadenocarcinoma 

Recklinghausens disease 

Renal cell adenocarcinoma 

Renal cell cancer 

Renal cell carcinoma 

Reticularproliferative disease 

Reticuloendothelial tumor 

Reticulum cell sarcoma 

Retinoblastoma 

Rhabdomyosarcoma 

Rhabdosarcoma 

Round cell cancer 

Round cell carcinoma 

Sarcoma 

Sarcomatosis 

Schilling type monocytic leukemia 

Schwannoma 

Scirrhous carcinoma 

Seminoma 

Serous adenocarcinoma 

Serous adenofibroma 

Serous cystadenocarcinoma 

Signet cell adenocarcinoma 

Sipples syndrome 

Small cell cancer 

Small cell carcinoma 

Small cell lymphoma 

Spindle cell cancer 

Spindle cell carcinoma 

Squamous cancer 

Squamous carcinoma 

Squamous cell cancer 

Squamous cell carcinoma 

Stem cell leukemia 

Subependymoma 

Subleukemic leukemia 

Synovial sarcoma 

T cell leukemia 

T cell lymphoma 

Teratoma 

Theca cell cancer 

Theca cell carcinoma 

Thecoma 

Thrombocythemia 

Thrombocytic leukemia 

Thymoma 

Transitional (cell) cancer 

Transitional (cell) carcinoma 

Transitional cell tumor 

Tumor 

Vaguez disease 

Vaguez Osler disease 

Vernet Morrison syndrome 

Verrucous carcinoma 

Villous adenocarcinoma 

Villous adenoma 

Von Recklinghausens disease 

Von Recklinghausens tumor 

WDHA syndrome 

Wilms tumor 

6) Unlikely underlying causes. Include an edit that flags the following as unlikely (nonspecific) underlying causes of 

death if reported on the lowest used line. The causes include:

Unknown 

Prematurity 

Immaturity 

Low birth weight 

Intrauterine hypoxia

The flagged causes would generate either a generic message similar to the message for the first automatic query but 

giving the certifier more leeway in reporting these conditions. The message to the certifier is: The condition you 

reported on 18a (“Prematurity”) usually develops as a complication of another more specific condition. Was 

there a specific initiating condition in this case? If so, please report it in 18a. The appropriate term should be 

used where Prematurity is shown as an example. 

STATE FILE CONSIDERATIONS: 

The outputs from the EFDR must allow manual coding now but be flexible for interfacing with future NCHS 

produced software for processing cause-of-death data. For the manual coders, they need to be able to know what 

was originally reported on the fetal death report and how it was reported. 
Item 18a,18b, page 25 

5/2004; Updated 2/18/2005 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAMES LENGTH TYPE VALUES

COD18a1 1 Alpha character string Y,N 

COD18a2 1 Alpha character string Y,N

COD18a3 1 Alpha character string Y,N

COD18a4 1 Alpha character string Y,N

COD18a5 1 Alpha character string Y,N

COD18a6 1 Alpha character string Y,N

COD18a7 1 Alpha character string Y,N

COD18a8 60 Alpha character string Literal, blank 

COD18a9 60 Alpha character string Literal, blank 

COD18a10 60 Alpha character string Literal, blank 

COD18a11 60 Alpha character string Literal, blank 

COD18a12 60 Alpha character string Literal, blank 

COD18a13 60 Alpha character string Literal, blank 

COD18a14 60 Alpha character string Literal, blank 

COD18b1 1 Alpha character string Y,N 

COD18b2 1 Alpha character string Y,N 

COD18b3 1 Alpha character string Y,N 

COD18b4 1 Alpha character string Y,N 

COD18b5 1 Alpha character string Y,N 

COD18b6 1 Alpha character string Y,N 

COD18b7 1 Alpha character string Y,N 

COD18b8 240 Alpha character string Literal, blank 

COD18b9 240 Alpha character string Literal, blank 

COD18b10 240 Alpha character string Literal, blank 

COD18b11 240 Alpha character string Literal, blank 

COD18b12 240 Alpha character string Literal, blank 

COD18b13 240 Alpha character string Literal, blank 

COD18b14 240 Alpha character string Literal, blank 

EDI TRANSMISSION: 
18c, page 1 

5/2004; Updated 2/18/2005 

Item Title: WEIGHT OF FETUS

 

Item Number: 18c Report, 25 Facility worksheet

 

Description: The weight of the fetus at delivery. 

Source of Information: 

Preferred Source: Delivery record, Admission assessment 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Wherever possible, weigh and report the fetal weight 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 fetal weight is not known, print or type “unknown” in the space. 

WEIGHT OF FETUS (grams preferred, specify unit) 

________________________ 

 grams  lb/oz 

FOR AN ELECTRONIC RECORD: 

EFDR Developer: (Instructions are in italics). 

The weight of the fetus 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 fetal weight item is to be completed.

Please check one box below. 

Note: hospitals which only use one unit to measure fetal weight 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. 

 Weight of fetus is measured in grams 

 Weight of fetus is measured in pounds and ounces 

When the box for grams is checked, the following appears:
18c, page 2 

5/2004; Updated 2/18/2005 

Weight of fetus___________________grams. 

When the pounds and ounces box is checked, the following appears: 

Weight of fetus ___________lbs. ____________ozs. 

The following instruction should appear in the help menu: 

Unknown fetal weight: If the weight of the fetus 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

FWG Fetus’s weight 0000-9998 Fetal weight in grams 

9999 Unknown 

FWP Fetus’s weight 00-20 Fetal weight pounds 

FWO Fetus’s weight 00-15 Fetal weight ounces 

99 Fetal weight pounds 

99 Fetal weight ounces 

FW_BYPASS Bypass flag 0 OFF 

1 Queried data correct, 

but out of range 

2 Queried, failed fetal 

weight/gestation edit. 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

Fetal weights in pounds and ounces are converted to grams and assigned to the FWG 

field for editing and tabulation purposes. (Do not convert unknown (99, 99) values for 

pounds and ounces.) 

The conversion algorithm is: 

FWG= ((FWP*16) + FWO)*28.35 
18c, page 3 

5/2004; Updated 2/18/2005 

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 fetal weight is ≤ 227 or ≥ 8165 but not 9999, the following message should appear: 

The weight of the fetus is _________________grams. 

Please check the box or enter a new weight. 

 Weight is correct 

Fetal weight is ____________ grams. 

If the “Fetal weight correct”box is checked the BW_BYPASS variable is set to ON-1. 

If a new fetal weight is entered the edit is rerun. If the edit fails, the FW_BYPASS 

variable is set to ON-1. If the edit passes, the FW_BYPASS variable is set to OFF-0. 

FETAL WEIGHT/GESTATION CONSISTENCY CHECK

The following edit is done if: the FW_BYPASS flag is 0, the fetal weight 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, FW <1,000 grams 

If C_GESTM is 5 and plurality is any valid value, FW < 2,000 grams 

If C_GESTM is 6 and plurality is any valid value, FW< 3,000 grams 

If C_GESTM is 7 and plurality is any valid value, FW <4,000 grams 

If C_GESTM is equal to or >8 and plurality is value 1, FW ≥ 1,000 grams. 

The following edit is done if: the FW_BYPASS flag is 0, the fetal weight 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, FW <1,000 grams 

If OWGEST is 20-23 and plurality is any valid value, FW < 2,000 grams 

If OWGEST is 24-27 and plurality is any valid value, FW< 3,000 grams 
18c, page 4 

5/2004; Updated 2/18/2005 

If OWGEST is 28-31 and plurality is any valid value, FW <4,000 grams 

IF OWGEST is 32-47 and plurality is value 1, FW ≥ 1,000 grams. 

If these edits fail, an error message appears that reads: 

The record indicates that the fetus has a gestation of _______months/weeks and a fetal 

weight of _________grams. 

Please check the correct box or enter a new fetal weight. 

 Fetal weight correct 

Fetal weight____________ grams 

If the “Fetal weight correct” box is checked, the FW_BYPASS flag is set to ON-2 

If a new fetal weight is entered, the edit is rerun. If the edit fails, the FW_BYPASS 

variable is set to ON-2. If the edit passes, the FW_BYPASS variable is set to OFF-0. 

PAPER RECORD 

Records filed with the fetal weight blank should be queried. If no response to query, 

assign 9999 to the fetal weight 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

FWG 4 Numeric 0000-9999 

FW_BYPASS 1 Numeric 0,1,2

 

EDI TRANSMISSION: 

No standards set yet. 
Item 18d, page 1 

5/2004; Updated 2/18/2005 

Item Title: OBSTETRIC ESTIMATION OF 

GESTATION AT DELIVERY

 

Item Number: 18d Report, 26 Facility worksheet

 

Description: The obstetric estimate of the infant’s gestation in 

completed weeks based on the delivery 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 fetus’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 fetus’s date of delivery and the patient’s date of 

LMP. 

OBSTETRIC ESTIMATE OF GESTATION AT DELIVERY: 

___________ (completed weeks) 

FOR AN ELECTRONIC RECORD: 

EFDR Developer (Instructions are in Italics) 

The obstetric estimate of the fetus’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 fetus’s 

gestation is not known, enter 99. Do not complete this item based on the fetus’s date of delivery and the 

patient’s date of LMP.
Item 18d, page 2 

5/2004; Updated 2/18/2005 

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 fetus’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 at delivery” blank should be 

queried. If no response to query, enter 99. 

State Edits of data file prior to NCHS transmission 

See above edits for electronic records. 
Item 18d, page 3 

5/2004; Updated 2/18/2005 

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 18e, page 1 

5/2004; Updated 2/18/2005 

Item Titles: ESTIMATED TIME OF FETAL DEATH 

Item Number: 18e Report; 38 Facility Worksheet

Description: Item to indicate when the fetus died with respect to labor 

and assessment.

Source of Information:

Preferred Source: Certifying Physician, Medical Examiner, or 

 Coroner 

INSTRUCTIONS 

FOR A PAPER RECORD: 

Certifying Physician, Medical Examiner, or Coroner 

 

Check the most appropriate box in item 18e. Estimated time of fetal death. 

 Dead at time of first assessment, no labor ongoing 

 Dead at time of first assessment, labor ongoing 

 Died during labor, after first assessment 

 Unknown time of fetal death 

FOR AN ELECTRONIC RECORD: 

EFDR Developer 

Select the most appropriate box from the list for item 18e. 

Estimated time of fetal death. 

 Dead at time of first assessment, no labor ongoing 

 Dead at time of first assessment, labor ongoing 

 Died during labor, after first assessment 

 Unknown time of fetal death

After a selection is made, go to the next item. 
Item 18e, page 2 

5/2004; Updated 2/18/2005 

PROCESSING VARIABLES 

NAME DESCRIPTION VALUES DEFINITION

ETIME Estimated time of fetal death N At assessment, no labor

 L At assessment, labor 

 A Labor, no assessment 

 U Unknown 

EDITS: 

ELECTRONIC RECORDS 

Before the record is transmitted to the State 

Electronic record for item 18e must contain one of the valid responses. They cannot be left blank. If items 

are left blank and certifier tries to move to the next item, a screen will appear asking that the item be 

completed at this time. Record cannot be printed or filed until this is complete. 

PAPER RECORDS 

Records filed with this field blank are queried. If no response to query, assign the “Unknown” code to 18e. 

State edits of data file prior to NCHS transmission 

STATE FILE CONSIDERATIONS 

No special considerations. 

 NCHS TRANSMISSION FILE 

VARIABLES: 

 NAMES LENGTH TYPE VALUES

ETIME 1 Alpha character string N,L,A,U 

EDI TRANSMISSION: 

No standards set yet.
Item 18f-18h, page 1 

5/2004; Updated 2/18/2005 

Item Titles: WAS AN AUTOPSY PERFORMED? 

WAS A HISTOLOGICAL PLACENTAL 

 EXAMINATION PERFORMED? 

WERE AUTOPSY OR HISTOLOGICAL 

PLACENTAL EXAMINATION RESULTS 

USED IN DETERMINING THE CAUSE OF 

FETAL DEATH? 

Item Number: 18f Report; 35 Facility Worksheet 

18g Report; 36 Facility Worksheet 

18h Report; 37 Facility Worksheet

Description: Information on whether or not an autopsy or histological 

placental examination was performed and if the findings 

of the autopsy or histological placental examination were 

used in completing the medical portion of the fetal death 

report.

Source of Information:

Preferred Source: Certifying Physician, Medical Examiner, or 

 Coroner 

INSTRUCTIONS 

FOR A PAPER RECORD: 

Certifying Physician, Medical Examiner, or Coroner 

 

Check the appropriate box in item 18f. Was an autopsy performed? 

 Yes 

 No 

 Planned 

Select “Yes” if a partial or complete autopsy was performed. 
Item 18f-18h, page 2 

5/2004; Updated 2/18/2005 

Check the appropriate box in item 18g. Was a histological placental examination performed? 

 Yes 

 No 

 Planned 

Select “Yes” if any histological placental examination was performed. 

If no is checked for both 18f and 18g, leave item 18h blank. 

If yes is checked for either 18f or 18g, complete item 18h (Were autopsy or histological placental 

examination results used in determining the cause of fetal death?) 

 Yes 

 No 

 

FOR AN ELECTRONIC RECORD: 

EFDR Developer 

Selection of “Yes” or “No” to be made from list. 

Was an autopsy performed? 

 Yes 

 No 

 Planned 

Instructions for help screen on this item 

Select “Yes” if a partial or complete autopsy was performed. 

Selection of “Yes” or “No” to be made from list. 

Was a histological placental examination performed? 

 Yes 

 No 

 Planned 

Instructions for help screen on this item 

Select “Yes” if a partial or complete histological placental examination was performed. 

If the response is no to both 18f and 18g, the next item will be skipped and the code for 

“Not applicable” automatically entered in the data field for item 18h. 
Item 18f-18h, page 3 

5/2004; Updated 2/18/2005 

If the response is yes to 18f or 18g, the yes/no list for item 18h appears: 

Were the results of the autopsy or histological placental examination results used in determining the 

cause of fetal death? 

 Yes 

 No 

After a selection is made, go to the next item. 

PROCESSING VARIABLES 

NAME DESCRIPTION VALUES DEFINITION

AUTOP Autopsy performed? Y Yes 

 N No 

 P Planned 

HISTOP Histological placental 

 Examination performed? Y Yes 

 N No 

 P Planned 

AUTOPF Autopsy or histological results Y Yes 

 Used? N No 

 X Not applicable 

EDITS: 

ELECTRONIC RECORDS 

Before the record is transmitted to the State 

Electronic record for item 18f and 18g must contain one of the valid responses (yes or no). They cannot be 

left blank. If items are left blank and certifier tries to move to the next item, a screen will appear asking that 

the item be completed at this time. Record cannot be printed or filed until this is complete. If the response 

to item 18f or 18g is “no,” item 18h will be coded to “Not applicable.” 

If response to item 18f or 18g is yes, then item 18h must have a valid response (yes or no). It cannot be left 

blank. If certifier tries to move to the next item, a screen will appear that indicates an autopsy had been 

performed and asks that a response be chosen from the menu. 

• If item 18f and 18g are N, item 18h must be X. 

• If item 18f or 18g is Y, item 18h must be Y or N. 

• Items 18f, 18g, and 18h cannot be blank. 

PAPER RECORDS 

 

Records filed with this field blank are queried. If no response to query, assign the “No” code to 18f and 

18g and the “Not applicable” code to item 18h. 

State edits of data file prior to NCHS transmission 
Item 18f-18h, page 4 

5/2004; Updated 2/18/2005 

STATE FILE CONSIDERATIONS 

No special considerations. 

 NCHS TRANSMISSION FILE 

VARIABLES: 

 NAMES LENGTH TYPE VALUES

AUTOP 1 Alpha character string Y, N, P 

HISTOP 1 Alpha character string Y, N, P 

 

AUTOPF 1 Alpha character string Y, N, X 

EDI TRANSMISSION: 

No standards set yet.
Item 19, page 1 

5/2004; Updated 2/18/2005 

Item Title: MOTHER/PATIENT’S EDUCATION

Item Number: 19 Report; 8 Mother/patient’s worksheet

Description: The highest degree or level of schooling completed by 

the mother/patient at the time of this delivery

Source of Information:

Preferred Source: Mother/patient or other informant 

INSTRUCTIONS 

FOR A PAPER RECORD: 

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

on the Report. If the patient leaves the item blank on the worksheet and she is still in the 

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

PATIENT’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 19, page 2 

5/2004; Updated 2/18/2005 

FOR AN ELECTRONIC RECORD: 

EFDR Developer (Instructions are in Italics)

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

when the item is to be completed. 

Patient’s Education 

Based on the patient’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 19, page 3 

5/2004; Updated 2/18/2005 

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

has left the facility, please check the box below. 

 Patient 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 EFDR or electronic work sheet, Patient’s date of birth will have 

been entered and edited. Patient’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 

8 23 

9 None 
Item 19, page 4 

5/2004; Updated 2/18/2005 

SAMPLE ERROR MESSAGE AND QUERY SCREENS 

The data entered in the electronic Report indicates an unlikely level of education 

for the patient at her age. 

Patient’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: 

Patient’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 patient’s date of birth, the patient’s date of birth 

screen appears. Please enter the correct date of birth 

Month of patient’s birth ___ ___ 

Day of patient’s birth ___ ___ 

Year of patient’s birth ___ ___ ___ ___ 
Item 19, page 5 

5/2004; Updated 2/18/2005 

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 20, page 1 

5/2004; Updated 2/18/2005 

Item Title: MOTHER/PATIENT OF HISPANIC 

 ORIGIN?

Item Number: 20 Report, 9 Mother/patient’s worksheet

Description: The Hispanic origin of the mother/patient.

Source of Information:

Preferred Source: Mother/patient or other informant 

 

INSTRUCTIONS 

FOR A PAPER RECORD: 

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

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

patient 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 patient indicates an 

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

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

print “Unknown.” 

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

patient is Spanish/Hispanic/Latina. Check the “No” box if patient 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: 

EFDR 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 patient’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 
Item 20, page 2 

5/2004; Updated 2/18/2005 

patient has chosen more than one response, check all that she has selected; 

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

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

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

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

Spanish/Hispanic/Latina.” 

 PATIENT 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 
Item 20, page 3 

5/2004; Updated 2/18/2005 

METHNIC2 Puerto Rican N No, not Puerto Rican 

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 patient 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. 

Must be valid codes (see above). 
Item 20, page 4 

5/2004; Updated 2/18/2005 

 

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 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 21, page 1 

5/2004; Updated 2/18/2005 

Item Title: MOTHER/PATIENT’S RACE 

Item Number: 21 Report, 10 mother/patient’s worksheet 

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

considers herself to be. 

Source of Information:

Preferred Source: The mother/patient 

INSTRUCTIONS 

PAPER RECORD 

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

corresponding checkboxes on the Report 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.” 

PATIENT’S RACE (Check one or more races to indicate what the patient 

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 21, page 2 

5/2004; Updated 2/18/2005 

FOR AN ELECTRONIC RECORD: 

EFDR 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 patient’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 

PATIENT’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 21, page 3 

5/2004; Updated 2/18/2005 

PROCESSING VARIABLES: 

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 

 

MRACE8 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 21, page 4 

5/2004; Updated 2/18/2005 

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 Patient 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 21, page 5 

5/2004; Updated 2/18/2005 

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. All the processing variables as initially recorded 

including all the literal entries are to be transmitted to NCHS along with the eight 

assigned codes for tabulation. To save States from the effort of duplicating this 

complicated process, NCHS will return the edited race codes to the States. 

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 21, page 6 

5/2004; Updated 2/18/2005 

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 21, page 7 

5/2004; Updated 2/18/2005 

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 22, page 1 

5/2004; Updated 2/18/2005 

Item Title: MOTHER/PATIENT MARRIED? 

Item Number: 22 Report; 11, 13 Mother/patient’s worksheet

 

Description: The marital status of the mother/patient at delivery, 

conception or any time in between. 

Source of Information: 

Preferred Source: Mother/patient 

 Other Source: Informant

INSTRUCTIONS 

FOR A PAPER RECORD: 

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

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

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

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

PATIENT MARRIED? (At delivery, conception, or any time between) 

 Yes  No 

FOR AN ELECTRONIC RECORD: 

EFDR developer: (Instructions are in italics) 

There are two questions required by this item: 

A. Has the patient ever been married? 

 Yes 

 No 

 Unknown at this time 

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

shown. (See item 10c). Once this is completed, question B appears. 

If the “No” box is checked, B is skipped and question 12a (father’s legal name) appears 

(if allowable under State law). 
Item 22, page 2 

5/2004; Updated 2/18/2005 

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

code, question B is skipped and the following message will appear: 

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

will appear on the final review screen. 

 B. Was the patient married at the time she conceived this child, at the time of delivery, or 

at any time between conception and delivery? 

 Yes 

 No 

PROCESSING VARIABLES: 

 

NAME DESCRIPTION VALUES DEFINITION

MARE Patient ever married Y Yes 

N No 

 U Unknown 

MARN Patient married at Y Yes 

conception, at delivery or N No 

any time in between 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. 

PAPER RECORD 

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

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

State Edits of data file prior to NCHS transmission 

See above edits for electronic records. 
Item 22, page 3 

5/2004; Updated 2/18/2005 

STATE FILE CONSIDERATIONS 

None. 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAME LENGTH TYPE VALUES

MARE 1 Alpha character string Y, N, U 

MARN 1 Alpha character string Y, N, U 

 

EDI TRANSMISSION: 

No standards set yet. 
Item 23a, 23b, page 1 

5/2004; Updated 2/18/2005 

Item Title: DATES OF FIRST AND LAST PRENATAL 

CARE VISIT

Item Number: 23a Report, 6a Facility worksheet 

 23b Report, 6b Facility worksheet 

Description: Date that the mother/patient had her first prenatal care 

visit. 

 Date that the mother/patient 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 patient’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 patient’s prenatal care record. The paragraph 

should also appear on an electronic worksheet just before the section of information to be 

obtained from the patient’s prenatal care record. 

“Information for this and the following items should come from the patient's 

prenatal care record and from other medical reports in the patient's chart, as well 

as the fetus's medical record. If the patient'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 patient 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 
Item 23a, 23b, page 2 

5/2004; Updated 2/18/2005 

________/______/_________ 

 MM DD YYYY 

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 patient 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 patient had no prenatal care, check the “no prenatal care” box and leave the date 

blank. 

 No Prenatal Care 

FOR AN ELECTRONIC RECORD: 

 

EFDR 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 

EFDR developers may wish to use “?” or a hot key for unknown dates 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. 
Item 23a, 23b, page 3 

5/2004; Updated 2/18/2005 

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 __ __ __ __ 

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 fetus’s delivery or yr of fetus’s 
Item 23a, 23b, page 4 

5/2004; Updated 2/18/2005 

 delivery –1, 8888,9999 

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 fetus’s delivery, or yr of fetus’s 

 delivery –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. 
Item 23a, 23b, page 5 

5/2004; Updated 2/18/2005 

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 

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 fetus’s date 

of delivery) shall be changed to “unknown” before transmission to NCHS. 
Item 23a, 23b, page 6 

5/2004; Updated 2/18/2005 

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 

fetus’s delivery 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 

fetus delivery 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.

. 
Item 23a, 23b, page 7 

5/2004; Updated 2/18/2005 

CALCULATION OF “THE MONTH PRENATAL CARE BEGAN”

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 
Item 23a, 23b, page 8 

5/2004; Updated 2/18/2005 

2. Convert days to months of pregnancy. 

Assume each month has 30.4 days (365/12) and use the following table: 

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 delivery as above and then 

 CD(OE)=CD(date of delivery)-(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 patient had no prenatal care, assign the “no prenatal care” code 88 for this derived 

variable.
Item 24, page 1 

5/2004; Updated 2/18/2005 

Item Title: TOTAL NUMBER OF PRENATAL CARE 

VISITS FOR THIS PREGNANCY

Item Number: 24 Report, 7 Facility worksheet

Description: Those visits which are listed in the mother/patient’s 

prenatal care and/or facility records 

Source of Information: 

Preferred Source: Prenatal care record 

 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

If the patient had no prenatal care, type or print “0” in the space. Note: the “no prenatal 

care” box should also be checked in item 23. 

If the patient 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: 

EFDR 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 patient’s records. 

Total number of prenatal care visits _______ 

The following message should also appear: 

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 
Item 24, page 2 

5/2004; Updated 2/18/2005 

EFDR 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 patient’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 23 is not 

marked. If the “no prenatal care” check box was marked in item 23, 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. 

If number of visits is “0,” the box for no prenatal care in item 23 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 24, page 3 

5/2004; Updated 2/18/2005 

Item 23 indicates that the patient 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 patient 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 23. A review screen for item 23 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 23 indicates that there was prenatal care, query. If item 23 

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 

 

 

NPREV_BYPASS 1 Numeric 0,1,2 

 

EDI TRANSMISSION: 

No standards set yet 
Item 25, page 1 

5/2004; Updated 2/18/2005 

Item Title: MOTHER/PATIENT’S HEIGHT 

Item Number: 25 Report, 18 Mother/patient’s worksheet

 

Description: The mother/patient’s height 

 

Source of Information: 

Preferred Source: The mother/patient 

Other Source: The mother/patient’s medical record 

 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

If the patient’s height is unknown, print or type “unknown” in the space. 

Enter the patient’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. 

PATIENT’S HEIGHT ___________(feet/inches) 

FOR AN ELECTRONIC RECORD: 

EFDR 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. 

 

 Patient’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 25, page 2 

5/2004; Updated 2/18/2005 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUE DEFINITION

HFT Patient’s height feet 1-8 Feet 

 9 Unknown 

HIN Patient’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 patient’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 25, page 3 

5/2004; Updated 2/18/2005 

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 26, page 1 

5/2004; Updated 2/18/2005 

Item Title: MOTHER/PATIENT’S PREPREGNANCY 

 WEIGHT 

 

Item Number: 26 Report, 19 Mother/patient’s worksheet

Description: The mother/patient’s prepregnancy weight 

 

Source of Information: 

Preferred Source: Mother/patient 

Other Source: Mother/patient’s Prenatal care record 

 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

If the patient’s prepregnancy weight is unknown, print or type “unknown” in the item’s 

space. 

Record weight in whole pounds only, do not include fractions. 

PATIENT’S PREPREGNANCY WEIGHT___________(pounds). 

FOR AN ELECTRONIC RECORD: 

EFDR Developer (Instructions are in Italics) 

The patient’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: 

 Patient’s prepregnancy weight___________pounds. 

If weight is unknown, enter 999. 
Item 26, page 2 

5/2004; Updated 2/18/2005 

PROCESSING VARIABLES: 

 NAME DESCRIPTION VALUES DEFINITION

PWGT Patient’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 patient’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 26, page 3 

5/2004; Updated 2/18/2005 

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 27, page 1 

5/2004; Updated 2/18/2005 

Item Title: MOTHER/PATIENT’S WEIGHT AT 

 DELIVERY

 

Item Number: 27 Report, 22 Facility worksheet 

 

Description: The mother/patient’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 patient’s delivery weight is unknown, print or type “unknown” in the item’s space. 

Record weight in whole pounds only, do not include fractions. 

PATIENT’S WEIGHT AT DELIVERY________(pounds) 

FOR AN ELECTRONIC RECORD: 

EFDR 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: 

Patient’s weight at delivery___________pounds. 

If weight is unknown, enter 999. 

PROCESSING VARIABLES: 

 NAME DESCRIPTION VALUES DEFINITION

DWGT Patient’s weight at delivery 50-450 

 999 unknown 

DWGT_BYPASS Edit flag for delivery weight 0 OFF 
Item 27, page 2 

5/2004; Updated 2/18/2005 

 1 ON (verified) 

2 ON (not verified) 
Item 27, page 3 

5/2004; Updated 2/18/2005 

EDITS: 

ELECTRONIC RECORD 

Before the record is transmitted to the State 

If patient’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: 

No standards set yet. 
Item 28, page 1 

5/2004; Updated 2/18/2005 

Item Title: DID MOTHER/PATIENT GET WIC FOOD 

FOR HERSELF DURING THIS 

PREGNANCY? 

 

Item Number: 28 Report, 17 Mother/patient’s worksheet

 

Description: Use of the Women, Infant’s and Children (WIC) 

nutritional program by the mother/patient during the 

pregnancy 

Source of Information: 

 Preferred Source: Mother/patient 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

This item is to be completed based on information obtained from the patient. Either the 

“yes” or “no” box must be checked. 

If the patient’s work sheet indicates “unknown,” print or type “unknown.” 

DID PATIENT GET WIC FOR HERSELF DURING THIS PREGNANCY? 

 Yes  No 

FOR AN ELECTRONIC RECORD: 

EFDR Developer (Instructions are in Italics) 

The item should be completed by keying the response recorded on the patient’s work 

sheet. The following list of choices should be provided. 

 Yes 

 No 

 Unknown 
Item 28, page 2 

5/2004; Updated 2/18/2005 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

 

WIC Patient’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 29a-c,30a-b, page 1 

5/2004; Updated 2/18/2005 

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: 29 a-c, 30 a-b Report; 

9, 10, 11, 12, 13 Facility worksheet 

Description: The pregnancy history of the mother/patient with respect 

to previous children born alive. 

The pregnancy history of the mother/patient 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 fetal death; include all previous live born 

infants. For multiple deliveries, include all live born infants preceding this fetus in the 

delivery. If first born in a multiple delivery, do not include this fetus. If second born, 

include the first born, etc. 

Please type or print the number of previous live born infants still living in item 29a, the 

number born alive now dead in item 29b, and the number of other pregnancy outcomes in 

item 30a. If there were none check the “none” boxes. If the number is unknown, type or 
Item 29a-c,30a-b, page 2 

5/2004; Updated 2/18/2005 

print “unknown” in the space. 

NUMBER OF PREVIOUS LIVE BIRTHS / OTHER PREGNANCY OUTCOMES 

(Do not include this fetus) 

29a. Now Living 29b. Now Dead 30a. 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 

29c. 

If the date of birth is not known, type or print “unknown” in the space. 

29c. 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 30b. 

If the date of delivery is not known, type or print “unknown” in the space. 

30b. DATE OF LAST OTHER PREGNANCY OUTCOME 

 ________/_____________ 

 MM YYYY 

FOR AN ELECTRONIC RECORD: 

EFDR 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 29a-c,30a-b, page 3 

5/2004; Updated 2/18/2005 

EFDR 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 patient’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 delivery 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. If the “unknown” box is checked for any of the 

variables the value 99 is assigned to the variable. 

EFDR developers may wish to use a hot key in lieu of checkboxes for unknown values. 

The following message should appear. 

When completing this item, do not include this fetal death. Do include any previous 

live born infants. If this was a multiple delivery, include all live born infants who 

preceded the fetal death in this delivery. If first born, do not include this fetus. 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 
Item 29a-c,30a-b, page 4 

5/2004; Updated 2/18/2005 

If there are any previous live born infants the following message should appear. 

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 patient’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 patient’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 

 (Patient’s year 

of birth plus 

10, through 

child’s year of 

birth) 

MOPO Month last other pregnancy outcome 01-12,88,99 Month number 
Item 29a-c,30a-b, page 5 

5/2004; Updated 2/18/2005 

YOPO Year other pregnancy outcome 4 digit yr, 

8888,9999 Year number 

 (Patient’s 

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 Patient’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. 
Item 29a-c,30a-b, page 6 

5/2004; Updated 2/18/2005 

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 ______. 

 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 patient as follows 

C_AGEM-LBO must be ≥ 8. 

If this value is < 8, the following message appears 

The patient is _______years of age and the record indicates: 

 ________Previous live births living 
Item 29a-c,30a-b, page 7 

5/2004; Updated 2/18/2005 

 ________Previous live births now dead 

 correct 

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 patient as follows: 

C_AGEM-TBO must be ≥8. 

If this value is less than 8, the following message appears 

The patient 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. 
Item 29a-c,30a-b, page 8 

5/2004; Updated 2/18/2005 

PAPER RECORD 

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 EFDR. 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 

(Patient’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 

(Patient’s year of 

birth plus 10 yrs 

through child’s year 

of delivery), 

8888,9999 
Item 29a-c,30a-b, page 9 

5/2004; Updated 2/18/2005 

EDI TRANSMISSION: 

 

No standards set yet. 
Item 31, page 1 

5/2004; Updated 2/18/2005 

Item Title: CIGARETTE SMOKING BEFORE AND 

DURING PREGNANCY 

Item Number: 31 Report, 20 Mother/patient’s worksheet

Description: The number of cigarettes or packs of cigarettes the 

mother/patient smoked 3 months before and at various 

intervals during the pregnancy 

Source of Information: 

Preferred Source: Mother/patient 

 

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 2/2005) that reflect the content of the cleared certificates. 

For item 31, the original version of the fetal death report 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 31 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 

patient. If the delivery did not occur in a facility, it is to be completed by the attendant or 

certifier based on information obtained from the patient. 

If the patient’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 31, page 2 

5/2004; Updated 2/18/2005 

 # 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: 

EFDR Developer (Instructions are in Italics)

The item should be completed by keying the response recorded on the patient’s work 

sheet. The following message and screen format is suggested: 

Check whether the patient 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 31, page 3 

5/2004; Updated 2/18/2005 

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 last trimester 0-98, 99 

CIGLP Number of packs smoked in last trimester 0.00-5.00 

 Unknown (all variables) 99 

EDITS: 

ELECTRONIC RECORD 

The variables CIGPN, CIGFN, CIGSN, CIGLN can not be blank and must have valid 

entries of 00-98, 99. 
Item 31, page 4 

5/2004; Updated 2/18/2005 

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 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.

State Edits of data file prior to NCHS transmission: 

Must be valid codes. 

NCHS TRANSMISSION FILE 

 

VARIABLES: 

 NAME LENGTH TYPE VALUE
Item 31, page 5 

5/2004; Updated 2/18/2005 

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 32, page 1 

5/2004; Updated 2/18/2005 

Item Title: DATE LAST NORMAL MENSES BEGAN

Item Number: 32 Report, 8 Facility worksheet

 

Description: Date that the mother/patient’s last normal menses began. 

This item is used to compute the gestational age of the 

fetus.

Source of Information: 

 Preferred Source: Mother/patient’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 patient’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: 

EFDR 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 32, page 2 

5/2004; Updated 2/18/2005 

EFDR 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. 

EFDR developers may wish to use a hot key in 9s for unknown values.

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_DOD Century month date of delivery 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 
Item 32, page 3 

5/2004; Updated 2/18/2005 

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. 

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 fetus’s 

year of delivery 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 delivery field must be 

compared with the date last normal menses began to be sure the date last normal menses 

began is earlier than the fetus’s date of delivery. If not, a message should appear and 

request that the inconsistency be resolved. 

Derived Variable for Editing Purposes 
Item 32, page 4 

5/2004; Updated 2/18/2005 

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. 

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_DOD - 

CM_DLNM. If either or both CM_DOD 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 DOD 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 fetus’s gestation age still is less than 0, please check and re-enter the 

fetus’s date of delivery. 

If 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 fetus’s date of delivery should 

be converted to unknown. 
Item 32, page 5 

5/2004; Updated 2/18/2005 

PAPER RECORD 

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, fetus’s 

yr of delivery 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 33,34, page 1 

5/2004; Updated 2/18/2005 

Item Titles: PLURALITY 

IF NOT SINGLE BIRTH – Born First, Second, 

Third, etc. (Specify) 

Item Numbers: 33 Report; 28 facility worksheet 

 34 Report; 29 facility worksheet 

 N/A Report; 30 facility worksheet 

Description: Plurality – The number of infants delivered live or dead 

at any time in the pregnancy regardless of gestational age 

or if delivered at different dates in the pregnancy. 

(“Reabsorbed” fetuses, those which are not “delivered” 

(expulsed or extracted from the mother/patient) should 

not be counted.) 

If not a singleton, specify delivered 1st, 2nd, etc. – For 

multiple deliveries, the order this infant was delivered in 

the set. Include all live births and fetal losses. 

If not a singleton, specify the number of fetal deaths in 

this delivery -- For multiple deliveries, the number of 

fetal deaths delivered at any point in the pregnancy. 

Source of Information: 

Preferred Source: Admission history and physical, Delivery record 

INSTRUCTIONS 

FOR A PAPER RECORD: 

 

Item 33, 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 33,34, page 2 

5/2004; Updated 2/18/2005 

Item 34, Set Order. 

If this is a singleton delivery, leave this item blank. For multiple deliveries, print the 

order that this fetal death 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: 

EFDR Developer: (Instructions are in italics)

Plurality 

Enter the number (live birth and fetal death) 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 delivered dead enter “3.” 

 

If plurality is unknown enter “99.” 

Plurality (number of live births and fetal deaths 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 fetus 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 fetal death__________ 

If plurality is >1 and not “99” the following question is asked: 

Enter the total number of fetal deaths in the delivery______ 

If “fetal deaths” > 1, an identification number unique to each multiple set delivered in 

the State for that year is generated. Each live birth and fetal death member of the set (if 
Item 33,34, page 3 

5/2004; Updated 2/18/2005 

the fetal death system is integrated with the birth) is assigned the same identification 

number. If the delivery includes a live birth the number may be generated from either the 

birth or fetal death systems. This number is entered for the variable “MATCH. The 

identification number may be the patient’s medical record number, or any other 

identifying number which would be unique to the multiple set for that State. 

Example: 

 Twin set A—1st born #345671 (live born) 

 2nd born #345671 (fetal death) 

Twin set B – 1st born #567897 (fetal death) 

 2nd born #567897 (fetal death) 

Triplet set A –1st born #789014 (fetal death) 

 2nd born #789014 (fetal death) 

 3rd born #789014 (live born) 

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., patient’s demographic and 

prenatal care information) is copied for each additional death. Only information 

potentially unique to the individual set member (e.g., method of delivery, weight at 

delivery) need be entered. ( See “Attachment to the Facility Worksheet for the Live Birth 

Report for Multiple Births” which can be modified to use for fetal deaths.) 

The purpose of generating identification numbers for multiple birth/delivery sets is to 

enhance quality control and to allow NCHS to more readily match members of multiple 

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 
Item 33,34, page 4 

5/2004; Updated 2/18/2005 

99 Unknown 

FDTH Number of fetal deaths 01-12 Number of fetal 

 deaths delivered 

 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 birth and fetal deaths in this delivery is recorded as_________________. 

Please indicate whether this number is “correct” or enter a new number. 

 correct 

Number (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.” 
Item 33,34, page 5 

5/2004; Updated 2/18/2005 

If plurality >1 but not “99,” “set order” must be ≤ plurality. 

 If this edit fails the following message occurs: 

The record indicates that there were ______births and fetal deaths in this delivery but the 

set order of this fetal death was_________. 

Please enter a new value for each of these items: 

Total number (live or dead) in this delivery____________ 

Set order of this fetal death _________ 

The edit is re-run and if it fails the bypass flag is set to ON-2. 

The number of fetal deaths 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 EFDR system should make sure that the correct number of 

records is completed for each fetal death in the multiple delivery by comparing the 

number for which the same identification number (MATCH) has been generated with the 

number reported as “fetal deaths“ (FDTH). 

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 FDTH 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. 
Item 33,34, page 6 

5/2004; Updated 2/18/2005 

For paper records keyed by the state, the matching numbers for multiple 

deliveries will have to be assigned at the state office in order to transmit 

values for the variable “match”. 

 

For multiple deliveries where there are one or more live births and one or 

more fetal deaths, obtain the match numbers from the live birth system. 

Otherwise, assign matching numbers and key enter the numbers for each 

fetal death in the multiple delivery. 

 

VARIABLES: 

NAME LENGTH TYPE VALUES

PLUR 2 Numeric 01-12, 99 

SORD 2 Numeric 01-12, 99 

FDTH 2 Numeric 01-12 99 

MATCH 6 Numeric 000001- 

 999999 

PLUR_BYPASS 1 Numeric 0,1,2 

 

EDI TRANSMISSION: 

No standards set yet. 
Item 35, page 1 

5/2004; Updated 2/18/2005 

Item Title: MOTHER/PATIENT TRANSFERRED FOR 

MATERNAL MEDICAL OR FETAL 

 INDICATIONS FOR DELIVERY? 

 

Item Number: 35 Report, 20 Facility work sheet

 

Description: Information of the transfer status of the mother/patient 

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 delivery did not occur in a facility, it is 

to be completed by the attendant or certifier and the response must be “no.” 

PATIENT TRANSFERRED FOR MATERNAL MEDICAL OR FETAL 

INDICATIONS FOR DELIVERY? 

 Yes  No 

IF YES, ENTER NAME OF FACILITY PATIENT TRANSFERRED 

FROM: 

________________________________________________________ 

If the name of the facility is not known, enter “unknown.” 
Item 35, page 2 

5/2004; Updated 2/18/2005 

FOR AN ELECTRONIC RECORD: 

EFDR Developer (Instructions are in Italics) 

If the response to Report item 7 is any response but hospital, this item is automatically 

completed with the “no” response and will not appear on the EFDR screen. 

Was the patient 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 patient transferred from. If the name of the 

facility is not known, enter “unknown.” 

Facility name:_____________________________ 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

TRAN Patient 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” 

is an acceptable entry. 
Item 35, page 3 

5/2004; Updated 2/18/2005 

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 7 must be “hospital.” If any response but 

“hospital”, a query message should appear. Either Report item 7 must be changed to 

“hospital” or Report item 35 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 Report item 7 must be “hospital.” If not, 

query. Either Report item 26 must be changed to “hospital” or Report item 35 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 

EDI TRANSMISSION: 

 

No standards set yet. 
Item 36, page 1 

5/2004; Updated 2/18/2005 

Item Title: RISK FACTORS IN THIS PREGNANCY

Item Number: 36 Report, 14 Facility worksheet

Description: Selected medical risk factors of the mother/patient during 

this 

pregnancy 

Source of Information: 

 Preferred source: Mother/patient’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 2/2005) that reflect the content of the cleared certificates. 

For item 36, the original version of the fetal death report 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 

fetal death report, the response categories for hypertension are: “prepregnancy (chronic),” “gestational 

(PIH, preclampsia),” and “eclampsia.” 

For item 36, the original version of the fetal death report 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 report does not include this checkbox. 

For item 36, the original version of the fetal death report 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 fetal death report, 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 patient may have more than one risk factor, check all that apply. 
Item 36, page 2 

5/2004; Updated 2/18/2005 

If the patient had none of the risk factors, check the “None of the above” box. 

If it is unknown if the patient 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)) 

 Patient had a previous cesarean delivery 

If yes, how many________ 

 None of the above 

FOR AN ELECTRONIC RECORD: 

EFDR 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 
Item 36, page 3 

5/2004; Updated 2/18/2005 

seizures or coma. May include pathologic edema. 

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 

EFDR 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 
Item 36, page 4 

5/2004; Updated 2/18/2005 

“unknown.” 

The following instruction should appear when the item is to be completed: 

Please check all the boxes that apply. If the patient 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)) 

 Patient 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 
Item 36, page 5 

5/2004; Updated 2/18/2005 

PPO Poor pregnancy outcomes Y, N, U 

INFT Infertility treatment Y, N, U 

INFT_DRG Infertility: Fertility Enhancing Drugs Y Yes 

 N No 

 X Not Applicable 

 U Unknown 

INFT_ART Infertility:Asst.Repr. 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 

box(es). 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 prepregnancy diabetes and gestational diabetes choices cannot both be checked. If 
Item 36, page 6 

5/2004; Updated 2/18/2005 

both boxes are checked, a message should appear that reads: 

Both the prepregnancy and gestational diabetes boxes are checked. Please 

review the records and choose the correct response. 

The eclampsia and either prepregnancy hypertension or gestational hypertention boxes 

may be checked. However, prepregnancy and gestational hypertension cannot both be 

checked. If both boxes are checked, a message should appear that reads: 

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 
Item 36, page 7 

5/2004; Updated 2/18/2005 

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 

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 is 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 “Patient 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 
Item 36, page 8 

5/2004; Updated 2/18/2005 

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 

VB 1 Alpha character string Y, N, U 

INFT 1 Alpha character string Y, N, U 

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 37, page 1 

5/2004; Updated 2/18/2005 

Item Title: INFECTIONS PRESENT AND/OR 

TREATED DURING THIS PREGNANCY 

Item Number: 37 Report, 15 Facility worksheet

Description: Selected infections that the mother/patient had or was 

treated for 

during the course of this pregnancy 

Source of Information: 

 Preferred Source: Mother/patient’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 2/2005) that reflect the content of the cleared certificates. 

For item 37, the original version of the fetal death report included a checkbox for “herpes simplex virus 

(HSV).” During the clearance process that checkbox was deleted. The final fetal death report 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 

 Listeria 

 Group B Streptococcus 

 Cytomeglovirus 

 Parvovirus 
Item 37, page 2 

5/2004; Updated 2/18/2005 

 Toxoplasmosis 

 None of the above 

 Other (Specify) _______________ 
Item 37, page 3 

5/2004; Updated 2/18/2005 

FOR AN ELECTRONIC RECORD: 

EFDR 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. 

Listeria (LM) – a diagnosis of or positive test for Listeria monocytogenes 

Group B Streptococcus (GBS) – a diagnosis of or positive test for Streptococcus 

agalactiae or group B streptococcus 

Cytomeglovirus (CMV) – a diagnosis of or positive test for Cytomeglovirus 

Parvovirus (B19) – a diagnosis of or positive test for Parvovirus B19 

Toxoplasmosis (Toxo) – a diagnosis of or positive test for Toxoplasmosis gondii 

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 

EFDR 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.” 
Item 37, page 4 

5/2004; Updated 2/18/2005 

The following instruction should appear when the item is to be completed: 

Please check all the boxes that apply. If the patient 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 

(Check all that apply)

 Gonorrhea 

 Syphilis 

 Chlamydia 

 Listeria 

 Group B Streptococcus 

 Cytomeglovirus 

 Parvovirus 

 Toxoplasmosis 

 None of the above 

 Other (Specify) _______________ 

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 

LM Listeria Y, N, U 

GBS Group B Streptococcus Y, N, U 

CMV Cytomeglovirus Y, N, U 

B19 Parvovirus Y, N, U 

TOXO Toxoplasmosis Y, N, U 

NOA02 None of the above Y, N, U 

OTHERI Other (Specify) Y, N, U 

 Alpha Character String 

DNA02 Pending flag 0 OFF 

1 ON 

 
Item 37, page 5 

5/2004; Updated 2/18/2005 

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 

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). 
Item 37, page 6 

5/2004; Updated 2/18/2005 

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 

LM 1 Alpha character string Y,N,U 

GBS 1 Alpha character string Y,N,U 

CMV 1 Alpha character string Y,N,U 

B19 1 Alpha character string Y,N,U 

TOXO 1 Alpha character string Y,N,U 

OTHERI 1 Alpha character string Y,N,U 

 

EDI TRANSMISSION: 

No standards set yet 
Item 38, page 1 

5/2004; Updated 2/18/2005 

Item Title: METHOD OF DELIVERY

Item Number: 38 Report, 23 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 

 

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 delivery 

 Cephalic 

 Breech 

 Other 

D. Final route and method of delivery (Check one) 

 Vaginal/Spontaneous 

 Vaginal/Forceps 

 Vaginal/Vacuum 

 Cesarean 

If cesarean, was a trial of labor attempted? 

 Yes 

 No 
Item 38, page 2 

5/2004; Updated 2/18/2005 

E. Hysterotomy/Hysterectomy 

 Yes 

 No 

FOR AN ELECTRONIC RECORD: 

EFDR 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.

• Hysterotomy/Hysterectomy: Hysterotomy – the incision into the uterus extending into the 

uterine cavity. May be performed vaginally or 

transabdominally. Hysterectomy – the surgical removal of the 

uterus. May be performed abdominally or vaginally. 
Item 38, page 3 

5/2004; Updated 2/18/2005 

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. 

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 delivery (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 38, page 4 

5/2004; Updated 2/18/2005 

E. Hysterotomy/Hysterectomy 

 Yes 

 No 

 Unknown at this time 

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 

HYST Hysterotomy/Hysterectomy Y, N, U 
Item 38, page 5 

5/2004; Updated 2/18/2005 

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 

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 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: 
Item 38, page 6 

5/2004; Updated 2/18/2005 

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. 

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. 

SECTION E. Hysterotomy/Hysterectomy 

Both hysterectomy and hysterectomy cannot be checked. 

More than one choice from the menu was selected. Please review and pick only one 

menu item. The menu list shall appear: 

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). 

 
Item 38, page 7 

5/2004; Updated 2/18/2005 

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 

HYST 1 Alpha character string Y, N, U 

 

EDI TRANSMISSION: 

No standards set yet 
Item 39, page 1 

5/2004; Updated 2/18/2005 

Item Title: MATERNAL MORBIDITY

Item Number: 39 Report, 24 Facility worksheet

Description: Serious complications experienced by the mother/patient 

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: 

EFDR 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 39, page 2 

5/2004; Updated 2/18/2005 

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 patient to a 

facility/unit designated as providing intensive care. 

 

Unplanned operating room procedure following delivery: Any transfer of the patient 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 

DNA05 Pending flag 0 OFF 

 1 ON 

 
Item 39, page 3 

5/2004; Updated 2/18/2005 

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 “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 39, page 4 

5/2004; Updated 2/18/2005 

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 40, page 1 

5/2004; Updated 2/18/2005 

Item Title: CONGENITAL ANOMALIES OF THE 

FETUS

Item Number: 40 Certificate, 31 Facility worksheet

Description: Malformations of the fetus diagnosed prenatally or after 

delivery 

Source of Information: 

Preferred Source: Labor and delivery summary, Fetal history and 

physical, Physician progress notes, Fetal admission 

history and physical

INSTRUCTIONS 

FOR A PAPER RECORD: 

CONGENITAL ANOMALIES OF THE FETUS 

Check all boxes that apply to this fetus. 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 40, page 2 

5/2004; Updated 2/18/2005 

FOR AN ELECTRONIC RECORD: 

EFDR 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 40, page 3 

5/2004; Updated 2/18/2005 

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 fetus 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 fetus are indicated, check the “None of the above” 

box. DO NOT LEAVE THIS ITEM BLANK. 

CONGENITAL ANOMALIES OF THE FETUS 

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 40, page 4 

5/2004; Updated 2/18/2005 

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 40, page 5 

5/2004; Updated 2/18/2005 

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 40, page 6 

5/2004; Updated 2/18/2005 

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 40, page 7 

5/2004; Updated 2/18/2005 

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 
File Processing Items 

Page 1 

 

5/2004; Updated 2/18/2005 

File Processing Item: State of delivery 

File Layout Location: 5-6 

Description: Information about the State of occurrence of the delivery. 

 

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 8 

(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 8 

(from FIPS table 5-2). 

EFDR Developer 

PROCESSING VARIABLES: 

NAME DESCRIPTION VALUES DEFINITION

DSTATE State of delivery Alpha Appendix B 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAMES LENGTH TYPE VALUES

DSTATE 2 Alpha character string Appendix B 
File Processing Items 

Page 2 

 

5/2004; Updated 2/18/2005 

File Processing Item: Report 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: 

EFDR 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 Items 

Page 3 

 

5/2004; Updated 2/18/2005 

File Processing Item: Void flag 

File Layout Location: 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: 

EFDR 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 Items 

Page 4 

 

5/2004; Updated 2/18/2005 

File Processing Item: Auxiliary state file number 

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: 

EFDR 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 12-digit Left fill zero if not 12 

File number digits, blank 
File Processing Items 

Page 5 

 

5/2004; Updated 2/18/2005 

NCHS TRANSMISSION FILE 

VARIABLES: 

NAMES LENGTH TYPE VALUES

AUXNO 12 Numeric character string 000000000001-999999999999, 

 blank 
 

5/2004; Updated 2/18/2005 

Appendix A 

TABLE OF COUNTRY CODES
Appendix A 

Page 1 

5/2004; Updated 2/18/2005 

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 
Appendix A 

Page 2 

5/2004; Updated 2/18/2005 

BULGARIA BU 

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 *
Appendix A 

Page 3 

5/2004; Updated 2/18/2005 

WEST GERMANY (FEDERAL 

REPUBLIC OF GERMANY) [September 

21, 1949 to October 3, 1990] 

GE *

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 
Appendix A 

Page 4 

5/2004; Updated 2/18/2005 

MALAYSIA MY 

MALDIVES MV 

MALI ML 

MALTA MT 

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 
Appendix A 

Page 5 

5/2004; Updated 2/18/2005 

SIKKIM [prior to 1975] SK *

SINGAPORE SN 

SLOVAKIA [as of January 1, 1993] LO 

CZECHOSLOVAKIA [October 28, 1918 

to January 1, 1993] 

CZ *

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 
Appendix A 

Page 6 

5/2004; Updated 2/18/2005 

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 *

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 
5/2004; Updated 2/18/2005 

Appendix B 

TABLE OF STATE, TERRITORY, AND 

CANADIAN PROVINCE CODES
Appendix B 

Page 1 

5/2004; Updated 2/18/2005 

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 

5/2004; Updated 2/18/2005 

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 
5/2004; Updated 2/18/2005 

Appendix C 

TABLE OF CITY AND COUNTY 

CODES
Appendix C 

Page 1 

5/2004; Updated 2/18/2005 

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/] 
 

5/2004; Updated 2/18/2005 

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) 
 

5/2004; Updated 2/18/2005 

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)