The CDC U.S. Standard Certificate of Live Birth form is a vital record that officially documents the birth of a child in the United States. This comprehensive document records important details such as the child's name, time and place of birth, parentage, and other relevant demographic information. It serves as a primary document for establishing identity, citizenship, and age. Ensure this form is accurately completed by clicking the button below.
The journey of life begins with a single, pivotal document: the U.S. Standard Certificate of Live Birth. Issued by the Centers for Disease Control and Prevention (CDC), this form embarks on capturing a child's first moments in the external world, establishing their identity and citizenship. It serves as the foundational record from which numerous rights, privileges, and responsibilities will flow throughout a person’s life. From securing a Social Security number to enrolling in school and eventually obtaining a driver's license or passport, the information documented on this certificate paves the way for these critical milestones. The form meticulously records vital details such as the date and place of birth, as well as parental information, ensuring a formal acknowledgment of a child's entry into society. However, its significance extends beyond the administrative; it collects vital statistics that play a crucial role in public health and policymaking. Understanding the nuanced aspects of this document is essential for parents and guardians to ensure that every child's rights are recognized and protected from the outset.
U.S. STANDARD CERTIFICATE OF LIVE BIRTH
LOCAL FILE NO.
BIRTH NUMBER:
C H I L D
1. CHILD’S NAME (First, Middle, Last, Suffix)
2. TIME OF BIRTH
3. SEX
4. DATE OF BIRTH (Mo/Day/Yr)
(24 hr)
5. FACILITY NAME (If not institution, give street and number)
6. CITY, TOWN, OR LOCATION OF BIRTH
7. COUNTY OF BIRTH
8b. DATE OF BIRTH (Mo/Day/Yr)
M O T H E R
8a. MOTHER’S CURRENT LEGAL NAME (First, Middle, Last, Suffix)
8c. MOTHER’S NAME PRIOR TO FIRST MARRIAGE (First, Middle, Last, Suffix)
8d. BIRTHPLACE (State, Territory, or Foreign Country)
9a. RESIDENCE OF MOTHER-STATE
9b. COUNTY
9c. CITY, TOWN, OR LOCATION
9d. STREET AND NUMBER
9e. APT.
NO.
9f. ZIP CODE
9g. INSIDE CITY
LIMITS?
□ Yes □ No
F A T H E R
10a. FATHER’S CURRENT LEGAL NAME (First, Middle, Last, Suffix)
10b. DATE OF BIRTH (Mo/Day/Yr)
10c. BIRTHPLACE (State, Territory, or Foreign Country)
CERTIFIER
11. CERTIFIER’S NAME: _______________________________________________
12. DATE CERTIFIED
13. DATE FILED BY REGISTRAR
TITLE: □ MD □ DO □ HOSPITAL ADMIN. □ CNM/CM □ OTHER MIDWIFE
______/ ______ / __________
□ OTHER (Specify)_____________________________
MM
DD
YYYY
MM DD
INFORMATION FOR ADMINISTRATIVE
USE
14. MOTHER’S MAILING ADDRESS:
9 Same as residence, or: State:
City, Town, or Location:
Street & Number:
Apartment No.:
Zip Code:
15. MOTHER MARRIED? (At birth, conception, or any time between)
□ Yes
□ No
16. SOCIAL SECURITY NUMBER REQUESTED
17. FACILITY ID. (NPI)
IF NO, HAS PATERNITY ACKNOWLEDGEMENT BEEN SIGNED IN THE HOSPITAL? □ Yes
FOR CHILD?
18. MOTHER’S SOCIAL SECURITY NUMBER:
19. FATHER’S SOCIAL SECURITY NUMBER:
INFORMATION FOR MEDICAL AND HEALTH PURPOSES ONLY
Mother’s Name ________________
Mother’s Medical Record No. _________________________
20. MOTHER’S EDUCATION (Check the
21. MOTHER OF HISPANIC ORIGIN? (Check
box that best describes the highest
the box that best describes whether the
degree or level of school completed at
mother is Spanish/Hispanic/Latina. Check the
the time of delivery)
“No” box if mother is not Spanish/Hispanic/Latina)
□
8th grade or less
No, not Spanish/Hispanic/Latina
□ Yes, Mexican, Mexican American, Chicana
9th - 12th grade, no diploma
Yes, Puerto Rican
High school graduate or GED
completed
Yes, Cuban
Some college credit but no degree
Yes, other Spanish/Hispanic/Latina
□ Associate degree (e.g., AA, AS)
(Specify)_____________________________
□Bachelor’s degree (e.g., BA, AB, BS)
□Master’s degree (e.g., MA, MS, MEng, MEd, MSW, MBA)
□Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, LLB, JD)
23. FATHER’S EDUCATION (Check the
24. FATHER OF HISPANIC ORIGIN? (Check
father is Spanish/Hispanic/Latino. Check the
“No” box if father is not Spanish/Hispanic/Latino)
No, not Spanish/Hispanic/Latino
□ Yes, Mexican, Mexican American, Chicano
Yes, other Spanish/Hispanic/Latino
22.MOTHER’S RACE (Check one or more races to indicate what the mother considers herself to be)
□White
□Black or African American
□American Indian or Alaska Native
(Name of the enrolled or principal tribe)________________
□Asian Indian
□Chinese
□Filipino
□Japanese
□Korean
□Vietnamese
□Other Asian (Specify)______________________________
□Native Hawaiian
□Guamanian or Chamorro
□Samoan
□Other Pacific Islander (Specify)______________________
□Other (Specify)___________________________________
25.FATHER’S RACE (Check one or more races to indicate what the father considers himself to be)
26. PLACE WHERE BIRTH OCCURRED (Check one)
27. ATTENDANT’S NAME, TITLE, AND NPI
28. MOTHER TRANSFERRED FOR MATERNAL
□ Hospital
NAME: _______________________ NPI:_______
MEDICAL OR FETAL INDICATIONS FOR
□ Freestanding birthing center
DELIVERY? □ Yes □ No
IF YES, ENTER NAME OF FACILITY MOTHER
□ Home Birth: Planned to deliver at home? 9 Yes 9 No
TITLE: □ MD □ DO □ CNM/CM □ OTHER MIDWIFE
TRANSFERRED FROM:
□ Clinic/Doctor’s office
□ OTHER (Specify)___________________
_______________________________________
□ Other (Specify)_______________________
REV. 11/2003
MOTHER
29a. DATE OF FIRST PRENATAL CARE VISIT
29b. DATE OF LAST PRENATAL CARE VISIT
30. TOTAL NUMBER OF PRENATAL VISITS FOR THIS PREGNANCY
______ /________/ __________ □ No Prenatal Care
______ /________/ __________
M M
D D
_________________________ (If none, enter A0".)
31. MOTHER’S HEIGHT
32. MOTHER’S
PREPREGNANCY WEIGHT
33. MOTHER’S WEIGHT
AT DELIVERY
34. DID MOTHER GET WIC FOOD FOR HERSELF
_______ (feet/inches)
_________ (pounds)
DURING THIS PREGNANCY? □ Yes □ No
35. NUMBER OF PREVIOUS
36. NUMBER OF OTHER
37. CIGARETTE SMOKING BEFORE AND DURING PREGNANCY
38. PRINCIPAL SOURCE OF
LIVE BIRTHS (Do not include
PREGNANCY OUTCOMES
For each time period, enter either the number of cigarettes or the
PAYMENT FOR THIS
this child)
(spontaneous or induced
number of packs of cigarettes smoked. IF NONE, ENTER A0".
DELIVERY
losses or ectopic pregnancies)
Average number of cigarettes or packs of cigarettes smoked per day.
□ Private Insurance
35a.
Now Living
35b. Now Dead
36a. Other Outcomes
Number _____
# of cigarettes
# of packs
□ Medicaid
Three Months Before Pregnancy
_________
OR
________
□ Self-pay
First Three Months of Pregnancy
□ Other
□ None
Second Three Months of Pregnancy _________
(Specify) _______________
Third Trimester of Pregnancy
35c. DATE OF LAST LIVE BIRTH
36b. DATE OF LAST OTHER
39. DATE LAST NORMAL MENSES BEGAN
40. MOTHER’S MEDICAL RECORD NUMBER
_______/________
PREGNANCY OUTCOME
Y Y Y Y
MEDICAL
41. RISK FACTORS IN THIS PREGNANCY
43. OBSTETRIC PROCEDURES (Check all that apply)
46. METHOD OF DELIVERY
(Check all that apply)
AND
Diabetes
□ Cervical cerclage
A. Was delivery with forceps attempted but
HEALTH
Prepregnancy
(Diagnosis prior to this pregnancy)
□ Tocolysis
unsuccessful?
Gestational
(Diagnosis in this pregnancy)
External cephalic version:
INFORMATION
B. Was delivery with vacuum extraction attempted
Hypertension
□ Successful
(Chronic)
□ Failed
but unsuccessful?
(PIH, preeclampsia)
□ None of the above
Eclampsia
C. Fetal presentation at birth
□ Previous preterm birth
Cephalic
44. ONSET OF LABOR (Check all that apply)
Breech
□ Other previous poor pregnancy outcome (Includes
□ Premature Rupture of the Membranes (prolonged, ∃12 hrs.)
Other
perinatal death, small-for-gestational age/intrauterine
D. Final route and method of delivery (Check one)
growth restricted birth)
□ Precipitous Labor (<3 hrs.)
□ Vaginal/Spontaneous
□ Pregnancy resulted from infertility treatment-If yes,
□ Prolonged Labor (∃ 20 hrs.)
□ Vaginal/Forceps
check all that apply:
□ Vaginal/Vacuum
□ Fertility-enhancing drugs, Artificial insemination or
□ Cesarean
Intrauterine insemination
If cesarean, was a trial of labor attempted?
□ Assisted reproductive technology (e.g., in vitro
45. CHARACTERISTICS OF LABOR AND DELIVERY
fertilization (IVF), gamete intrafallopian
(Check all that
apply)
transfer
(GIFT))
Induction of labor
47. MATERNAL MORBIDITY (Check all that apply)
□ Mother had a previous cesarean delivery
(Complications associated with labor and
Augmentation of labor
If yes, how many __________
delivery)
Non-vertex presentation
Maternal transfusion
□ Steroids (glucocorticoids) for fetal lung maturation
□ Third or fourth degree perineal laceration
42. INFECTIONS PRESENT AND/OR TREATED
received by the mother prior to delivery
Ruptured uterus
DURING THIS
PREGNANCY (Check all that apply)
□ Antibiotics received by the mother during labor
Unplanned hysterectomy
□ Clinical chorioamnionitis diagnosed during labor or
□ Admission to intensive care unit
Gonorrhea
maternal temperature >38°C (100.4°F)
□ Unplanned operating room procedure
Syphilis
□ Moderate/heavy meconium staining of the amniotic fluid
following delivery
Chlamydia
□ Fetal intolerance of labor such that one or more of the
Hepatitis B
following actions was taken: in-utero resuscitative
Hepatitis C
measures, further fetal assessment, or operative delivery
□ Epidural or spinal anesthesia during labor
NEWBORN
Mother’s Medical Record No. ____________________
NEWBORN INFORMATION
48. NEWBORN MEDICAL RECORD NUMBER
54. ABNORMAL CONDITIONS OF THE NEWBORN
55. CONGENITAL ANOMALIES OF THE NEWBORN
49. BIRTHWEIGHT (grams preferred, specify unit)
Assisted ventilation required immediately
Anencephaly
Meningomyelocele/Spina bifida
______________________
Cyanotic congenital heart disease
9 grams 9 lb/oz
Congenital diaphragmatic hernia
Assisted ventilation required for more than
Omphalocele
six hours
50. OBSTETRIC ESTIMATE OF GESTATION:
Gastroschisis
_________________ (completed weeks)
NICU admission
Limb reduction defect (excluding congenital
amputation and dwarfing syndromes)
Newborn given surfactant replacement
□ Cleft Lip with or without Cleft Palate
Cleft Palate alone
therapy
51. APGAR SCORE:
Down Syndrome
Score at 5 minutes:________________________
Antibiotics received by the newborn for
Karyotype confirmed
If 5 minute score is less than 6,
Score at 10 minutes: _______________________
suspected neonatal sepsis
Karyotype pending
Seizure or serious neurologic dysfunction
Suspected chromosomal disorder
52. PLURALITY - Single, Twin, Triplet, etc.
□ Significant birth injury (skeletal fracture(s), peripheral
Hypospadias
(Specify)________________________
nerve
injury, and/or soft tissue/solid organ hemorrhage
None of the anomalies listed above
which
requires intervention)
53. IF NOT SINGLE BIRTH - Born First, Second,
Third, etc. (Specify) ________________
9 None of the above
56. WAS INFANT TRANSFERRED WITHIN 24 HOURS OF DELIVERY? 9 Yes 9 No
57. IS INFANT LIVING AT TIME OF REPORT?
58. IS THE INFANT BEING
IF YES, NAME OF FACILITY INFANT TRANSFERRED
□ Yes □ No □ Infant transferred, status unknown
BREASTFED AT DISCHARGE?
TO:______________________________________________________
Rev. 11/2003
NOTE: This recommended standard birth certificate is the result of an extensive evaluation process. Information on the process and resulting recommendations as well as plans for future
activities is available on the Internet at: http://www.cdc.gov/nchs/vital_certs_rev.htm.
Filling out the CDC U.S. Standard Certificate of Live Birth form is a crucial step in ensuring that a newborn's entry into the world is officially recognized. This document is essential for legal identification, applying for social security numbers, and will be useful throughout the individual’s life for various registrations and official purposes. By following a clear, step-by-step process, the task can be completed efficiently and accurately. Remember, the information provided should be double-checked for correctness to avoid future complications.
Steps for Filling Out the CDC U.S. Standard Certificate of Live Birth Form:
Once completed, review the form thoroughly to ensure all information is accurate and complete. Mistakes can lead to delays in processing or may require the form to be filled out again, so taking the time to double-check is crucial. After review, submit the form as directed by your local health department or the entity that provided you with the form. Submitting the form promptly ensures that the birth is legally documented and that the necessary processes, such as applying for a Social Security number, can begin without delay.
What is the purpose of the CDC U.S. Standard Certificate of Live Birth form?
The CDC U.S. Standard Certificate of Live Birth form serves as an official document, issued by the government, to record the birth of a child within the United States. Its main purpose is to officially recognize the birth, providing a legal record of the child's name, date of birth, place of birth, as well as detailed information about the parents. This documentation is essential for various legal and personal purposes, including securing a social security number, enrolling in school, and establishing citizenship.
Who is responsible for completing the CDC U.S. Standard Certificate of Live Birth form?
The completion of the CDC U.S. Standard Certificate of Live Birth form is a shared responsibility. Health care providers, typically those present at the birth, are responsible for filling out the medical information related to the birth and the newborn. This includes details such as the time of birth, the physical condition of the newborn, and the medical procedures performed. The parents of the newborn are responsible for providing personal demographic information, which includes names, addresses, and social security numbers. Accuracy in completing this form is crucial, as the information becomes part of the legal record.
How can one obtain a copy of the birth certificate after the CDC U.S. Standard Certificate of Live Birth form is filed?
Once the CDC U.S. Standard Certificate of Live Birth form is filed with the local or state vital records office, individuals can request a certified copy of the birth certificate through the same office. Request procedures and fees can vary by state and locality. Typically, requests can be made in person, by mail, or online, requiring the requester to provide sufficient identification and, in most cases, a fee. It is advisable to check the specific requirements with the relevant local or state vital records office.
Is the information provided on the CDC U.S. Standard Certificate of Live Birth form kept confidential?
Yes, the information collected on the CDC U.S. Standard Certificate of Live Birth form is held in strict confidence by the vital records offices. Access to the detailed information contained in the birth record is typically restricted to the individual named on the record, immediate family members, or legal representatives. Certain public health and safety organizations may access aggregate data for statistical purposes, but such data do not include personally identifying information.
What should one do if they find an error on a birth certificate that was based on the CDC U.S. Standard Certificate of Live Birth form?
In the event an error is discovered on a birth certificate that was based on information provided in the CDC U.S. Standard Certificate of Live Birth form, it is essential to rectify this mistake promptly. The procedure to correct an error varies by state and the nature of the incorrect information. Generally, it involves submitting a request for correction to the vital records office where the birth was registered, along with the required proof or affidavits that substantiate the correct information. Since policies and procedures can differ significantly, contacting the specific state or local vital records office directly for guidance is advisable.
Not reviewing the form for completeness: Often, individuals overlook the importance of double-checking the form for missing entries. Every field should be reviewed to ensure no information is left out, as incomplete forms may lead to processing delays or require corrections later on.
Incorrectly filling out the baby’s name: The baby's name is a critical piece of information, yet it's common for people to make errors in spelling or to add nicknames instead of the legal name. This can lead to identity verification issues in the future.
Misreporting the place of birth: The location where the birth took place must be accurately recorded. Errors in this section can affect the child’s eligibility for certain state or country-specific benefits.
Failing to record accurate parental information: Sometimes, important details regarding the parents, such as their full names, birthplaces, and dates of birth, are inaccurately recorded. Accurate parental information is crucial for legal and health reasons.
Overlooking the importance of the informant’s details: The person who fills out the form, known as the informant, must also provide their full name, address, and relationship to the child. Errors or omissions in this section can complicate the form’s legality.
Incorrect data entry for twins or multiple births: When documenting births of twins, triplets, or more, special care must be taken to correctly indicate each child's order of birth and to fill out separate forms if required. Confusing this information can lead to inaccuracies in official records.
Not using legible handwriting or print: If the form is filled out by hand, illegible handwriting can lead to misinterpretation of crucial information. It's recommended to print clearly to avoid any confusion.
Delaying the submission of the form: Timeliness is essential in submitting the Certificate of Live Birth. Delays can interfere with the timely registration of the birth, which may impact health coverage and other benefits.
While filling out the CDC U.S. Standard Certificate of Live Birth form, attention to detail and an understanding of the form’s requirements are crucial. Avoiding the common mistakes listed above will help ensure that the birth is accurately and efficiently documented, laying a strong foundation for the baby’s legal and identification records. It is advisable for individuals to seek guidance from hospital staff or a legal advisor if there is any confusion or concern.
When a child is born in the United States, the CDC U.S. Standard Certificate of Live Birth is a key document recorded. However, to fully establish a newborn's identity, parental rights, and start their life within the legal and social systems of the country, several other documents are commonly used in conjunction with this certificate. These documents each serve unique purposes, from ensuring a child's right to healthcare to acknowledging their citizenship.
Together, these documents create a comprehensive legal identity for a newborn, facilitating their healthcare, education, travel, and proving their relationship to their parents or guardians. While the list can seem daunting at first, each document serves a specific role in ensuring the child's rights and well-being from the very start of their life.
Certificate of Death: Like the U.S. Standard Certificate of Live Birth, the Certificate of Death collects comprehensive data about an individual at the end of their life. Both documents record key personal details, such as full name, date, and place, though one marks the beginning and the other the end of a person's legal existence.
Marriage Certificate: This document is similar as it serves as a vital record, officially documenting a significant life event. Both the Marriage Certificate and the Certificate of Live Birth are used for legal identification, to apply for passports, and in various legal settings needing proof of relationship or status.
Adoption Certificate: Both the Adoption Certificate and the Certificate of Live Birth establish the legal identification of an individual. The Adoption Certificate replaces the biological parents' names with those of the adoptive parents, functioning in many respects like the birth certificate for future legal identification purposes.
Certificate of Naturalization: Similar in its function as a foundational identity document, the Certificate of Naturalization proves a person's citizenship status, much like the Certificate of Live Birth proves one's birth and identity within a country. Both are used to apply for passports and other legal documents.
Passport: A Passport is an international travel document that also serves as proof of nationality, akin to how the Certificate of Live Birth serves as proof of identity and citizenship within a country. Both documents include essential information such as full name, date, and place of birth.
Driver's License: While primarily used as a permit to drive, a Driver's License also functions as a widely accepted form of identification, showing the holder's name, date of birth, and photograph. This parallels the Certificate of Live Birth, which is the first form of identification issued at birth.
Social Security Card: Issued soon after birth in the United States, a Social Security Card is necessary for tax and employment purposes and serves as part of an individual's legal identification framework alongside the Certificate of Live Birth. Both are essential for accessing various social services and rights.
Filling out the CDC U.S. Standard Certificate of Live Birth form is a critical process that helps in officially recognizing a new member of the community. To ensure the information is accurate and accepted without delay, here are a few essential dos and don'ts:
Do:
Don’t:
Understanding the intricacies of the U.S. Standard Certificate of Live Birth form, issued by the Centers for Disease Control and Prevention (CDC), is crucial for new parents and professionals alike. Several common misconceptions surround this document, which can lead to confusion and misinformation. Here, the aim is to clarify these misunderstandings with accurate information.
It is essential for individuals to seek out accurate information and guidance when filling out the U.S. Standard Certificate of Live Birth to ensure the document's correctness and completeness. Understanding these common misconceptions can help in avoiding mistakes that could have lasting consequences for the child and family.
The CDC U.S. Standard Certificate of Live Birth serves as a crucial document, capturing the essential details surrounding a newborn's entry into the world. Here are some key takeaways to ensure its proper use and completion:
Understanding these facets of the U.S. Standard Certificate of Live Birth form ensures that the birth of a child is properly documented, reflecting accurately on personal and public records. This document is not just a formality; it's a foundational part of a person's legal and societal identity.
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