Vital Records Birth and Fetal Death Reporting
1.1.0 - STU 1.1 United States of America flag

This page is part of the Vital Records Birth and Fetal Death Reporting (v1.1.0: STU 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

Appendix A - Example Facility Worksheet for the Live Birth Certificate

Example of a completed Facility Worksheet for the Live Birth Certificate:

Example Facility Worksheet for Live Birth Certificate for Baby G Quinn - p1
Example Facility Worksheet for Live Birth Certificate for Baby G Quinn - p2
Example Facility Worksheet for Live Birth Certificate for Baby G Quinn - p3
Example Facility Worksheet for Live Birth Certificate for Baby G Quinn - p4
Example Facility Worksheet for Live Birth Certificate for Baby G Quinn - p5
Example Facility Worksheet for Live Birth Certificate for Baby G Quinn - p6
Example Facility Worksheet for Live Birth Certificate for Baby G Quinn - p7
Example Facility Worksheet for Live Birth Certificate for Baby G Quinn - p8