Information collected on the confidential section of live birth and fetal death certificates; modifications to the United States standard certificates and report forms.

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