WAC 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

(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 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" 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"