Date of Adoption: September 11, 2002.

     Purpose: The amendments update the rules to assure the vital statistic certificates are consistent with U.S. standard certificates, as required under chapter 70.58 RCW. The amendments also improve the clarity of the chapter.

     Citation of Existing Rules Affected by this Order: Amending WAC 246-491-029, 246-491-039, and 246-491-149.

     Statutory Authority for Adoption: RCW 43.70.150, 70.58.055.

     Other Authority: Chapter 70.58 RCW.

      Adopted under notice filed as WSR 02-16-100 on August 7, 2002.

     Changes Other than Editing from Proposed to Adopted Version: Birth Certificate: Item 4 (under Type of Birthplace) added: "Planned birthplace if different ."

     Fetal Death Certificate: Item 5 (under Type of Birthplace) added: "Planned birthplace if different ."

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 2, Amended 3, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 2, Amended 3, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 2, Amended 3, Repealed 0.
     Effective Date of Rule: Thirty-one days after filing.

Don Sloma

Executive Director

State Board of Health

M. C. Selecky

Secretary

Department of Health

OTS-5810.2

NEW SECTION
WAC 246-491-001   Purpose.   RCW 70.58.055 requires certificates for vital records to include, at a minimum, items recommended by the federal agency responsible for national vital statistics. RCW 70.58.055 allows the state board of health to require additional information for the confidential section of the birth certificate, and eliminate items from the federal forms that it identifies as not necessary for statistical study.

     RCW 43.70.150 requires the secretary of the department of health to operate and maintain a state system for registering births, deaths, fetal deaths, marriages, divorce decrees, annulments and separations. RCW 43.70.160 requires the state registrar to prepare, print and supply the forms for registering, recording, and preserving vital statistics. These rules identify the forms used and information collected by the state on live birth, death, fetal death, marriage, divorce, dissolution of marriage and annulment.

[]

     (1) "Board" means the state board of health.

     (2) "Department" means the department of health.

[]

     (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
	Add "Spanish" to "of Hispanic origin."
	Add "or descent? (ancestry)" to "of Hispanic origin."
	Add "Asian or Pacific Islander" to "race."
	Add "occupation" and "type of business or industry" for both parents.
	Add "parental identification of ethnicity and race of child."
	Add "twenty weeks or more, less than twenty weeks" to "pregnancy history."
	Add separate categories for "spontaneous" and "induced" terminations to "pregnancy history."
	Add "total prior pregnancies."
	Add under the heading "medical risk factors for this pregnancy," "polyhydramnios, genital herpes, syphilis, "hepatitis B-HBsAg positive."
	Add under the heading "method of delivery," "C-section with no labor, C-section with trial of labor."
	Add under the heading "abnormal conditions of the newborn," drug withdrawal syndrome in newborn.
	Delete under 38a "hydramnios."
	Delete under item 37b "name of facility infant transferred to."
	Add under the heading "other risk factors for pregnancy," "weight before pregnancy."
	Add under the heading "complication of labor and/or delivery," "nuchal cord."
	Change "tobacco use during pregnancy" to "did mother smoke at any time during pregnancy"?
	Add "principal source of payment for prenatal care."
	Add "during pregnancy mother participated in (special programs)."))

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
	Add "or descent? (ancestry)" to "of Hispanic origin."
	Add "Spanish" to "of Hispanic origin."
	Add "Asian or Pacific Islander" to "race."
	Add "twenty weeks or more, less than twenty weeks" to "other pregnancy outcomes."
	Add under the heading "medical risk factors for this pregnancy" "polyhydramnios, first trimester bleeding, epilepsy, genital herpes, syphilis."
	Add separate categories for "spontaneous" and "induced" terminations to "pregnancy history."
	Add "total prior pregnancies."
	Add "fetal hemorrhage, placenta and cord conditions (specify), hemolytic disease, fetal hydrops, shoulder dystocia, other (specify), and none."
	Add "C-section with no labor" and "C-section with trial of labor."
	Add under the heading "other risk factors for pregnancy," "weight before pregnancy."
	Change "tobacco use during pregnancy" to "did mother smoke at any time during pregnancy"?
	Add "principal source of payment for prenatal care."
	Add "during pregnancy mother participated in (special programs)."
	Delete under item 23a "hydramnios and uterine bleeding."
	Delete under item 26 "hysterotomy/hysterectomy."))

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: 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.]

[Statutory Authority: Chapter 70.58 RCW. 91-20-073 (Order 196B), § 246-491-039, filed 9/26/91, effective 10/27/91. Statutory Authority: RCW 43.20.050. 91-02-051 (Order 124B), recodified as § 246-491-039, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 70.58.200. 88-19-092 (Order 310), § 248-124-015, filed 9/20/88.]

     (2) Effective January 1, 2004, the department shall use the 2003 standard form for death.

     (3) Effective January 1, 1992, the department shall use the 1988 revisions of the United States standard forms for marriage and dissolution.

     (4) These forms are developed by the United States Department of Health and Human Services, National Center for Health Statistics. Copies of these forms may be obtained by contacting the department's center for vital statistics.

     (5) With the exception of the confidential section, the department may modify any part of these forms ((and shall make the following modifications:)). Tables 3, 4, and 5 identify the modifications to the United States standard forms for live birth, fetal death, and death. Tables 6 and 7 identify modifications to the United States standard form for marriage, and certificate of divorce, dissolution of marriage, or annulment.

((U.S. STANDARD CERTIFICATE OF LIVE BIRTH.
	Add "mother's request to issue Social Security number (allow up to six months)."
	Add "record amendment."
	Add "how long at current residence"?

U.S. STANDARD CERTIFICATE OF DEATH.
	Under "place of death" add "in transport," "hospital."
	Add "smoking in last fifteen years."
	Add "or descent" after "of Hispanic origin."
	Add "length of residence."
	Add "date of disposition."
	Add "medical examiner/coroner file number."
	Add "hour pronounced dead (24-hours)."
	Add "record amended section."
	Delete "license number (funeral director)" under item 21b.
	Delete "license number (certifier)" under item 23b.
	Delete "were autopsy findings available prior to completion of cause of death yes/no" under item 28b.
	Delete check boxes under item 20a.
	Delete "donation" under item 20a.
	Delete check boxes under item 31a.
	Delete item 32.
	Delete "inpatient" under item 9a.
	Delete check boxes under item 29.
	Delete "natural" under item 29.

U.S. STANDARD REPORT OF FETAL DEATH.
	Add "fetus name."
	Add "time of delivery."
	Add "place of delivery."
	Add "state of birth."
	Add "registrar signature."
	Add "date filed."
	Add "burial, cremation, removal, other (specify)."
	Add "date (burial)."
	Add "cemetery/crematory-name."
	Add "location (cemetery)."
	Add "funeral director signature."
	Add "name of facility."
	Add "address of facility."
	Add "autopsy yes/no."
	Add "were autopsy findings used to complete the cause of death"?
	Add "certification statement."
	Change title to "certificate of fetal death."

U.S. STANDARD LICENSE AND CERTIFICATE OF MARRIAGE.
	Change title to "certificate of marriage."
	Add "type of ceremony (religious/civil ceremony)."
	Add "officiant - date signed."
	Add "inside of city limits for bride and groom."
	Delete "age last birthday" for the groom under item 2.
	Delete "age last birthday" for the bride under item 9.
	Delete "license to marry" section.
	Delete "expiration date of license" under item 17.
	Delete "title of issuing official" under item 20.
	Delete "confidential information" under items 27 through 30b.

U.S. STANDARD CERTIFICATE OF DIVORCE, DISSOLUTION OF MARRIAGE, OR ANNULMENT.
	Change title to "certificate of dissolution, declaration of invalidity of marriage or legal separation."
	Add check boxes for "type of decree."
	Add "inside city limits" for both parties.
	Delete "date couple last resided in same household" under item 11.
	Change "number of children under eighteen in this household as of this date" to "number of children born alive of this marriage" under item 12.
	Delete check boxes for "petitioner" under item 13.
	Delete section "number of children under eighteen whose physical custody was awarded to" under item 18.
	Delete "title of court" under item 20.
	Delete "title of certifying official" under item 22.
	Delete "date signed" under item 23.
	Delete "confidential information" under items 24 through 27b.))

U.S. STANDARD CERTIFICATE OF LIVE BIRTH
Table 3: Legal or Public Birth Certificate Items
Item Number	Item Name	Difference from U.S. Standard, if any
1	Child's name
2	Child's date of birth
3	Time of birth
4	Type of birthplace	Add "En route," Add "Planned birthplace if different"
5	Child's sex
6	Name of facility
7	City, town or location of birth
8	County of birth
9	Mother's name before first marriage
10	Mother's date of birth
11	Mother's birthplace
12	Mother's Social Security number
13	Mother's current legal last name
14	Social Security number requested for child?
16a	Mother's residence - number, street, and Apt. No.
16b	Mother's residence - city or town
16c	Mother's residence - county
16d	Tribal reservation name (if applicable)	Added
16e	Mother's residence - state or foreign country
16f	Mother's residence - zip code + 4
16g	Mother's residence - inside city limits?
17	Telephone number	Added
18	How long at current residence?	Added
19	Mother's mailing address, if different
25	Father's current legal name
26	Father's date of birth
27	Father's birthplace
28	Father's Social Security number
66	Certifier name and title	Delete check boxes
67	Date certified
68	Attendant name and title	Delete check boxes
69	NPI of person delivering the baby
---	Date filed by registrar	Deleted

U.S. STANDARD REPORT OF FETAL DEATH
Table 4: Legal or Public Fetal Death Certificate Items
Item Number	Item Name	Difference from U.S. Standard, if any
1	Name of fetus
2	Sex
3	Date of delivery
4	Time of delivery
5	Type of birthplace	Add "En route," Add "Planned birthplace if different"
6	Name of facility
7	Facility ID (NPI)
8	City, town or location of birth
9	Zip code of delivery
10	County of birth
11	Mother's name before first marriage
12	Mother's date of birth
13	Mother's current legal last name
14	Mother's birthplace
15a	Mother's residence - number, street, and Apt. No.
15b	Mother's residence - city or town
15c	Mother's residence - county
15d	Tribal reservation name (if applicable)	Added
15e	Mother's residence - state or foreign country
15f	Mother's residence - zip code + 4
15g	Mother's residence - inside city limits?
16	How long at current residence?	Added
17	Father's current legal name
18	Father's date of birth
19	Father's birthplace
20	Name and title of person completing the report
21	Date report completed
22	Attendant name and title	Delete check boxes
23	NPI of person delivering the baby
24	Method of disposition
25	Date of disposition
26	Place of disposition	Added
27	Location of disposition - city/town and state	Added
28	Name and complete address of funeral facility	Added
29	Funeral director signature	Added
30	Initiating cause/condition (cause of death)
31	Other significant causes or conditions
32	Estimated time of fetal death
33	Was an autopsy performed?
34	Was a histological placental examination performed?
35	Were autopsy or histological placental examination results used in determining the cause of death?
36	Registrar signature	Added
37	Date received

U.S. STANDARD CERTIFICATE OF DEATH
Table 5: Death Certificate Items
Item Number	Item Name	Difference from U.S. Standard, if any
1	Legal name (include a.k.a.'s if any)
2	Death date
3	Sex
4a	Age - years
4b	Age - under 1 year
4c	Age - under 1 day
5	Social Security number
6	County of death
7	Birth date
8a	Birth place - city, town or county
8b	Birth place - state or foreign country
9	Decedent's education	Add "Specify": next to box for "8th Grade or less"
10	Decedent's Hispanic origin
11	Decedent's race
12	Was decedent ever in U.S. Armed Forces?
13a	Residence - number and street
13b	Residence - city or town
13c	Residence - county
13d	Tribal reservation name (if applicable)	Added
13e	Residence - state or foreign country
13f	Residence - zip code
13g	Inside city limits?
14	Estimated length of time at residence	Added
15	Marital status at time of death
16	Surviving spouse's name
17	Occupation
18	Kind of business/industry
19	Father's name
20	Mother's name before first marriage
21	Informant - name
22	Informant - relationship to decedent
23	Informant - address
24	Place of death
25	Facility name (if not a facility, give number and street)
26a	City, town, or location of death
26b	State of death
27	Zip code of death
28	Method of disposition
29	Place of disposition (name of cemetery, crematory, other place)
30	Disposition - city/town, and state
31	Name and complete address of funeral facility
32	Date of disposition	Added
33	Funeral director signature
34	Causes of death and intervals between onset and death
35	Other significant conditions contributing to death
36	Autopsy?
37	Were autopsy findings available to complete the cause of death?
38	Manner of death
39	Pregnancy status
40	Did tobacco use contribute to death?
41	Date of injury
42	Hour of injury
43	Place of injury
44	Injury at work?
45	Injury location - street, city, county, state, zip	County Added
46	Describe how injury occurred
47	Transport injury type
48a	Certifying physician signature
48b	Medical examiner/coroner signature
49	Name and address of certifier
50	Hour of death
51	Name and title of attending physician if other than certifier	Added
52	Date certified
53	Title of certifier
54	License number of certifier
55	ME/coroner file number	Added
56	Was case referred to medical examiner?
57	County registrar signature	Added
58	County date received	Added
59	Record amendment	Added
--	License number of funeral director	Deleted
--	Date pronounced dead	Deleted
--	Time pronounced dead	Deleted
--	Signature of person pronouncing death	Deleted
--	License number of person pronouncing death	Deleted
--	Date person pronouncing death signed	Deleted

U.S. STANDARD LICENSE AND CERTIFICATE OF MARRIAGE
Table 6: Certificate of Marriage
Item Number	Item Name	Difference from U.S. Standard, if any
--	Certificate name	Changed name of form to "Certificate of Marriage”
--	County of license
--	Date valid
--	Not valid after (date)
1	Date of marriage
2	County of ceremony
3	Type of ceremony	Added
4	Date signed (by officiant)	Added
5	Officiant's name
6	Officiant's signature
7	Officiant's address
8	Groom's name
9	Groom's address (street)
10	Groom's date of birth
11	Groom's place of birth (state or country)
12	Groom's address (city)
13	Groom's address (inside city limits)	Added
14	Groom's address (county)
15	Groom's address (state)
16	Groom's father - name
17	Groom's father - place of birth
18	Groom's mother - maiden name
19	Groom's mother - place of birth
20	Groom's signature
21	Date signed (by groom)
22	Bride's name
23	Bride's maiden last name
24	Bride's residence - (street)
25	Bride's date of birth
26	Bride's place of birth (state or country)
27	Bride's residence (city)
28	Bride's residence (inside city limits)	Added
29	Bride's residence (county)
30	Bride's residence (state)
31	Bride's father - name
32	Bride's father - place of birth
33	Bride's mother - maiden name
34	Bride's mother - place of birth
35	Bride's signature
36	Date signed (by bride)
37	Witness #1 signature
38	Witness #2 signature
39	County auditor signature
40	Date received (by county auditor)
Reverse side		Groom's Social Security number
Reverse side		Bride's Social Security number
	Groom's age last birthday	Deleted
	Bride's age last birthday	Deleted
	License to marry section	Deleted
	Expiration date of license	Deleted
	Title of issuing official	Deleted
	Confidential information	Deleted

U.S. STANDARD CERTIFICATE OF DIVORCE, DISSOLUTION OF MARRIAGE, OR ANNULMENT
TABLE 7: Certification of Dissolution, Declaration of Invalidity of Marriage, or Legal Separation
Item Number	Item Name	Difference from U.S. Standard, if any
	Certificate name	Changed form name to certificate of dissolution, declaration of invalidity of marriage or legal separation
	Court file number
1	Type of decree	Added check boxes
2	Date of filing
3	County where decree filed
4	Signature of superior court clerk
5	Husband's name
6	Husband's date of birth
7	Husband's place of birth
8	Husband's residence - street
9	Husband's residence - city
10	Husband's residence - inside city limits	Added
11	Husband's residence - county
12	Husband's residence - state
13	Wife's name
14	Wife's maiden name
15	Wife's date of birth
16	Wife's place of birth
17	Wife's residence - street
18	Wife's residence - city
19	Wife's residence - inside city limits	Added
20	Wife's residence - county
21	Wife's residence - state
22	Place of marriage - county
23	Place of marriage - state
24	Date of marriage
25	Number of children of this marriage	Name change
26	Petitioner	Delete check boxes
27	Name of petitioner's attorney/pro se
28	Petitioner's address
29	Husband's Social Security number
30	Wife's Social Security number
	Date couple last resided in same household	Delete
	Number of children under 18 whose physical custody was awarded to	Delete
	Title of court	Delete
	Title of certifying official	Delete
	Date signed	Delete
	Confidential information	Delete

[Statutory Authority: RCW 43.70.150. 91-23-026 (Order 211), § 246-491-149, filed 11/12/91, effective 12/13/91. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-491-149, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 43.20A.620. 88-19-034 (Order 2696), § 248-124-160, filed 9/12/88.]

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