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 R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Appendix C - Example Facility Worksheet for the Fetal Death Report

Example of a completed Facility Worksheet for the Fetal Death Report:

Example Facility Worksheet for Fetal Death Report - p1
Example Facility Worksheet for Fetal Death Report - p2
Example Facility Worksheet for Fetal Death Report - p3
Example Facility Worksheet for Fetal Death Report - p4
Example Facility Worksheet for Fetal Death Report - p5
Example Facility Worksheet for Fetal Death Report - p6