Washington Administrative Code › Title 246 - Health, Department of › HEALTH INFORMATION › Chapter 246-491 - Vital statistics - Certificates › Section 246-491-029 - Information collected on the confidential section of live birth and fetal death certificates; modifications to the United States standard certificates and report forms

Current through Register Vol. 24-14, July 15, 2024
(1) Effective
				January 1, 2003, the department shall use the 2003 revisions of the United
				States standard forms of live birth and fetal death as the basis for the state
				certificates of live birth and fetal death. These forms are developed by the
				United States Department of Health and Human Services, National Center for
				Health Statistics.
(2) Copies of
				these forms may be obtained by contacting the department's center for vital
				statistics.
(3) Tables 1 and 2 list
				the statistical information contained in the confidential sections of the birth
				and fetal death certificates that the board requires the department to collect,
				and the differences between the state and U.S. standard.
U.S. STANDARD CERTIFICATE OF LIVE BIRTH
TABLE 1:
Confidential Birth Certificate
								Items
Item Number
Item Name
Difference from U.S. Standard, if
								any
15
Is mother married to the father?
If no, was mother married to anyone during the
								pregnancy?
Added
Has the paternity affidavit been signed?
20
Mother's education
Add "Specify": next to box for "8th Grade or
								less"
21
Mother of Hispanic origin?
22
Mother's race
23
Mother's occupation
Added
24
Mother's kind of business/industry
Added
29
Father's education
Add "Specify": next to box for "8th Grade or
								less"
30
Father of Hispanic origin?
31
Father's race
32
Father's occupation
Added
33
Father's kind of business/industry
Added
34
Mother's medical record number
35
Mother's prepregnancy weight
36
Mother's weight at delivery
37
Mother's height
38
Did mother get WIC food for herself during
								pregnancy?
39
Cigarette smoking before and during
								pregnancy
40a
Number of previous live births
40b
Date of last live birth
41a
Number of other pregnancy outcomes
41b
Date of last other pregnancy outcome
42a
Date of first prenatal care visit
42b
Date of last prenatal care visit
43
Total number of prenatal visits for this
								pregnancy
44
Date last normal menses began
45
Was mother transferred to higher-level care for
								maternal medical or fetal indications for delivery?
46
Principal source of payment for this
								delivery
Add "Indian Health" and "CHAMPUS"
47
Newborn medical record number
48
Birth weight
49
Infant head circumference
Added
50
Obstetric estimate of gestation
51
Apgar score at 5 min; if score is less than 6,
								score at 10 minutes
52
Plurality
53
If not single birth - born 1st, 2nd, 3rd
								etc.
54
Was infant transferred within 24 hours of
								delivery?
55
Is infant living at time of the report?
56
Is infant being breastfed?
57
Risk factors in this pregnancy
Add "Group B streptococcus culture positive"
58
Method of delivery
59
Infections present and/or treated during this
								pregnancy
Add "HIV infection" and "Other: Specify"
60
Obstetric procedures
61
Abnormal conditions of the newborn
62
Characteristics of labor and delivery
63
Congenital anomalies of the newborn
64
Maternal morbidity
65
Onset of labor
U.S. STANDARD REPORT OF FETAL DEATH
TABLE 2:
Confidential Fetal Death Certificate
								Items
Item Number
Item Name
Difference from U.S. Standard, if
								any
38
Weight of fetus
39
Obstetric estimate of gestation
40
Plurality
41
If not single birth - Born 1st, 2nd, 3rd
								etc.
42
Mother's education
Add "Specify": next to box for "8th Grade or
								less"
43
Mother of Hispanic origin?
44
Mother's race
45
Mother's occupation
Added
46
Mother's kind of business/industry
Added
47
Mother married?
48
Mother's height
49
Did mother get WIC food for herself during
								pregnancy?
50
Mother's prepregnancy weight
51
Mother's weight at delivery
52
Date last normal menses began
53
Date of first prenatal care visit
54
Date of last prenatal care visit
55
Total number of prenatal visits for this
								pregnancy
56a
Number of previous live births
56b
Date of last live birth
57a
Number of other pregnancy outcomes
57b
Date of last other pregnancy outcome
58
Cigarette smoking before and during
								pregnancy
59
Was mother transferred to higher-level care for
								maternal medical or fetal indications for delivery?
60
Father's education
Added
61
Father of Hispanic origin?
Added
62
Father's race
Added
63
Father's occupation
Added
64
Father's kind of business/industry
Added
65
Risk factors in this pregnancy
66
Method of delivery
67
Congenital anomalies of the fetus
68
Maternal morbidity
69
Infections present and/or treated during this
								pregnancy
Add "HIV infection" and "Other:
Specify"
Statutory Authority:
					 RCW
					 43.70.150,
					 70.58.055, and
					 chapter
					 70.58 RCW. 02-20-092,
					 § 246-491-029, filed 10/1/02, effective 11/1/02. Statutory Authority:
					 Chapter
					 70.58 RCW. 91-20-073
					 (Order 196B), § 246-491-029, filed 9/26/91, effective 10/27/91. Statutory
					 Authority:
					 RCW
					  43.20.050. 91-02-051 (Order 124B), recodified
					 as § 246-491-029, filed 12/27/90, effective 1/31/91. Statutory Authority:
					 RCW 70.58.200. 88-19-092 (Order 310), § 248-124-010, filed 9/20/88.
					 Statutory Authority:
					 RCW
					  43.20.050 and 70.58.200. 84-02-004 (Order
					 270), § 248-124-010, filed 12/23/83; Order, § 248-124-010, filed
					 9/1/67.