Guide to Completing the Facility Worksheets for the Certificate of Live Birth and Report of Fetal Death

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This guide was developed to assist in completing the facility worksheets for the Certificate of Live Birth and Report of Fetal Death (2003 revision).

It provides item numbers, definitions, instructions, best sources, and expected keywords and abbreviations.

For additional training, see Applying Best Practices for Reporting Medical and Health Information on Birth Certificates.

Tips for Using this Guidebook

This guide provides definitions, instructions, sources, and keywords and abbreviations for each item on the facility worksheets of the Certificate of Live Birth and the Report of Fetal Death.

Items are shown as follows:

#. Item name (number refers to the order in which the question appears on the U.S. Standard Certificate of Live Birth)

Category: (All items are in a larger category)

BC # (Number on the U.S. Standard Certificate of Live Birth)

FDFWS # (Number on the facility worksheet for the Report of Fetal Death)

FDR # (Number on the Report of Fetal Death)

Definitions, instructions, sources, keywords and abbreviations
Definitions	Defines the item
Instructions	If needed, provides specific instructions for completing each item
Sources	Identifies the sources in the medical records where information for each item can be found. The specific records available will differ somewhat from facility to facility. The source listed first is considered the best or preferred source. Please use this source whenever possible. All subsequent sources are listed in the order of preference. The precise location within the records where an item can be found is further identified by under and or.	Example: To determine whether gestational diabetes is recorded as a “Risk factor in this pregnancy” (item #14) in the records: The first or best source is the prenatal care record. Within the prenatal care record, information on diabetes may be found under: Medical history Previous obstetric (OB) history Problem list or initial risk assessment Historical risk summary Complications of previous pregnancies Factors in this pregnancy
Keywords and Abbreviations	Identifies alternative terms (usually synonymous) and common abbreviations and acronyms for items. The keywords and abbreviations given in this guide are not intended to be exhaustive; facilities and practitioners will likely add to the list.	Example: Keywords and abbreviations for prepregnancy diabetes are: DM – Diabetes mellitus Type 1 diabetes IDDM – Insulin dependent diabetes mellitus Type 2 diabetes Noninsulin dependent diabetes mellitus Class B DM Class C DM Class D DM Class F DM Class R DM Class H DM
	Medications commonly used for items.	Example: “Clomid” for “Assisted reproduction treatment.”
	Look for is used to indicate terms that may be associated with, but are not synonymous with, an item. Terms listed under look for may indicate that an item should be reported for the pregnancy, but additional information will be needed before it can be determined whether the item should be reported.	Example: “Trial of labor” for “cesarean delivery.”

Mother: The woman who gave birth to, or delivered the infant.

All birth certificate information reported for the mother should be for the woman who delivered the infant.

In cases of surrogacy or gestational carrier, the information reported should be for the surrogate or the gestational carrier, that is, the woman who delivered the infant.

Where information for an item cannot be located, please check “unknown” or write “unknown” (if using the paper copy of the worksheet).

Choose an Item

Birth certificate items are divided into 4 categories depending on whether the item relates to the birth facility, the mother’s pregnancy history, labor and delivery, or the infant. Selecting a category will limit the items listed to only those in the category. To return to the full list of items, click the Clear button.

Found 41 items.

1. Facility name

The name of the facility where the delivery took place.

Categories: Facility Information

2. Facility ID

National Provider Identifier.

Categories: Facility Information

3. City, town, or location of birth

The name of the city, town, township, village, or other location where the birth occurred.

Categories: Facility Information

4. County of birth

The name of the county where the birth occurred.

Categories: Facility Information

5. Place where birth occurred (Birthplace)

The type of place where the birth occurred.

Categories: Facility Information

6. Date of the first prenatal care visit

The date a physician or other health care professional first examined or counseled the pregnancy woman for the pregnancy.

Categories: Prenatal Care and Pregnancy History

7. Total number of prenatal care visits for this pregnancy

The total number of visits recorded in the record.

Categories: Prenatal Care and Pregnancy History

8. Date last normal menses began

The date the mother’s last normal menstrual period began.

Categories: Prenatal Care and Pregnancy History

9. Number of previous live births now living

The total number of previous live-born infants now living.

Categories: Prenatal Care and Pregnancy History

10. Number of previous live births now dead

The total number of previous live-born infants now dead.

Categories: Prenatal Care and Pregnancy History

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Guide to Completing the Facility Worksheets for the Certificate of Live Birth and Report of Fetal Death

Tips for Using this Guidebook

How to Use This Guide

Who is the mother?

What to do with missing information

Choose an Item