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

Vital Records Forms Mapping

This IG supports communicating information from an EHR system to the jurisdictional vital records offices and to NCHS for standard reporting forms:

Live Birth

Fetal Death

The following tables map the form elements to the appropriate profile or extension along with the containing specification:

The Profile/Extension column contains a link to the profile or extension that contains the specific data element. Where there are dot separated pieces in the link, the bolded part of the link is the target. The non-bolded parts of the link are for context:

The last two tables on this page map the Patient’s Worksheets to the Questionnaires.

Information on updates to the live birth and fetal death forms can be found at NVSS Revisions of the U.S. Standard Certificates and Reports and Guide to Completing the Facility Worksheets for the Certificate of Live Birth and Report of Fetal Death

2003 Revision of the U.S. Standard Certificate of Live Birth Mapping

Form Element Profile/Extension Location
2003 Revision of the U.S. Standard Certificate of Live Birth Local File No. Composition-provider-live-birth-report.extension.Extension-live-birth-local-file-number BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth Birth Number Composition-provider-live-birth-report.extension.Extension-live-birth-certificate-number BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 1. Child’s Name Patient-child-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 2. Child’s Time of Birth Patient-child-vr.extension.patient-birthTime FHIR
2003 Revision of the U.S. Standard Certificate of Live Birth 3. Child’s Sex Patient-child-vr.extension.us-core-birthsex US CORE
2003 Revision of the U.S. Standard Certificate of Live Birth 4. Child’s Date Of Birth Patient-child-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 5. Facility Name / Address Encounter-birth.location.location.us-core-location.location.location US CORE
2003 Revision of the U.S. Standard Certificate of Live Birth 6. City, Town, Or Location Of Birth Patient-child-vr.extension.patient-birthPlace FHIR
2003 Revision of the U.S. Standard Certificate of Live Birth 7. County Of Birth Patient-child-vr.extension.patient-birthPlace FHIR
2003 Revision of the U.S. Standard Certificate of Live Birth 8a. Mother’s Current Legal Name Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 8b. Mother’s Date Of Birth Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 8c. Mother’s Name Prior To First Marriage Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 8d. Mother’s Birthplace Patient-child-vr.extension.patient-birthPlace FHIR
2003 Revision of the U.S. Standard Certificate of Live Birth 9a. Residence of Mother - State Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 9b. Mother’s County Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 9c. Mother’s City, Town, or Location Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 9d. Mother’s Street And Number Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 9e. Mother’s Apt. No. Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 9f. Mother’s Zip Code Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 9g. Mother’s Residence Inside City Limits? Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 10a. Father’s Current Legal Name RelatedPerson-father-natural-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 10b. Father’s Date Of Birth RelatedPerson-father-natural-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 10c. Father’s Birthplace Extension-relatedperson-birthplace-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 11. Certifier’s Name Practitioner-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 11. Certifier’s Title Practitioner-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 12. Date Certified Encounter-birth.participant:certifier.period.start BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 13. Date Filed By Registrar Composition-provider-live-birth-report.extension.Extension-date-filed-by-registrar BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 14. Mother’s Mailing Address Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 15. Mother Married? Observation-mother-married-during-pregnancy BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 16. Social Security Number Requested for Child? Observation-ssn-requested-for-child BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 17. Facility Id. Encounter-birth.us-core-location.identifier US CORE
2003 Revision of the U.S. Standard Certificate of Live Birth 18. Mother’s Social Security Number Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 19. Father’s Social Security Number RelatedPerson-father-natural-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 20. Mother’s Education Observation-parent-education-level-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 21. Mother of Hispanic Origin? Patient-child-vr.extension.us-core-ethnicity US CORE
2003 Revision of the U.S. Standard Certificate of Live Birth 22. Mother’s Race Patient-child-vr.extension.us-core-race US CORE
2003 Revision of the U.S. Standard Certificate of Live Birth 23. Father’s Education Observation-parent-education-level-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 24. Father of Hispanic Origin? Patient-child-vr.extension.us-core-ethnicity US CORE
2003 Revision of the U.S. Standard Certificate of Live Birth 25. Father’s Race Patient-child-vr.extension.us-core-race US CORE
2003 Revision of the U.S. Standard Certificate of Live Birth 26. Place Where Birth Occurred Encounter-birth.location.physicalType BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 26.a. Home Birth: Planned to deliver at home? Observation-planned-to-deliver-at-home BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 27. Attendant’s Name Practitioner-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 27. Attendant’s Title Practitioner-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 27. Attendant’s NPI Practitioner-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 28. Mother Transferred for Maternal Medical or Fetal Indications for Delivery? Encounter-maternity.hospitalization.admitSource (Y if present, N if not present) BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 29a. Date Of First Prenatal Care Visit Observation-date-of-first-prenatal-care-visit BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 30. Total Number Of Prenatal Visits For This Pregnancy Observation-number-prenatal-visits-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 31. Mother’s Height Observation-mother-height-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 32. Mother’s Prepregnancy Weight Observation-mother-prepregnancy-weight-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 33. Mother’s Weight At Delivery Observation-mother-delivery-weight-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 34. Did Mother Get WIC Food For Herself During This Pregnancy? Observation-mother-received-wic-food BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 35. Number of Previous Live Births Observation-number-births-now-dead-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 36. Number of Other Pregnancy Outcomes Observation-number-other-pregnancy-outcomes-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 37. Cigarette Smoking Before And During Pregnancy Observation-cigarette-smoking-before-during-pregnancy BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 38. Principal Source of Payment for This Delivery Coverage-principal-payer-for-delivery BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 39. Date Last Normal Menses Began Observation-last-menstrual-period-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 40. Mother’s Medical Record Number Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 41.1. Risk factors in this pregnancy: Diabetes - Prepregnancy Condition-prepregnancy-diabetes-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 41.2. Risk factors in this pregnancy: Diabetes - Gestational Condition-gestational-diabetes-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 41.3. Risk factors in this pregnancy: Hypertension - Prepregnancy Condition-prepregnancy-hypertension-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 41.4. Risk factors in this pregnancy: Hypertension - Gestational Condition-gestational-hypertension-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 41.5. Risk factors in this pregnancy: Eclampsia Condition-eclampsia-hypertension-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 41.6. Risk factors in this pregnancy: Previous preterm births Observation-previous-preterm-birth-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 41.8. Risk factors in this pregnancy: Pregnancy resulted from infertility treatment Procedure-infertility-treatment-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 41.9. Risk factors in this pregnancy: Fertility-enhancing drugs, artificial insemination or intrauterine insemination Procedure-artificial-insemination-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 41.10. Risk factors in this pregnancy: Assisted reproductive technology Procedure-assisted-fertilization-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 41.11. Risk factors in this pregnancy: previous cesarean delivery Observation-previous-cesarean-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 41.12. Risk factors in this pregnancy: None of the above Observation-none-of-specified-pregnancy-risk-factors-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 42. Infections present and/or treated during this pregnancy Condition-infection-present-during-pregnancy BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 43. Obstetric Procedures Procedure-obstetric BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 45.1. Characteristics of Labor and Delivery: Induction of labor Procedure-induction-of-labor BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 45.2. Characteristics of Labor and Delivery: Augmentation of labor Procedure-augmentation-of-labor BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 45.4. Characteristics of Labor and Delivery: Steroids for fetal lung maturation Observation-steroids-fetal-lung-maturation BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 45.5. Characteristics of Labor and Delivery: Antibiotics received by the mother during labor Observation-antibiotics-during-labor BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 45.6. Characteristics of Labor and Delivery: Clinical chorioamnionitis Condition-chorioamnionitis BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 45.9. Characteristics of Labor and Delivery: Epidural or spinal anesthesia during labor Procedure-epidural-or-spinal-anesthesia BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 45.10. Characteristics of Labor and Delivery: None of the above Observation-none-of-specified-characteristics-labor-delivery BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 46.C. Fetal presentation at birth Observation-fetal-presentation BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 46.D. Final route and method of delivery Procedure-final-route-method-delivery BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 46.D.1. If cesarean, was a trial of labor attempted? Observation-labor-trial-attempted BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 47.1. Maternal Morbidity: Maternal transfusion Procedure-blood-transfusion BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 47.2. Maternal Morbidity: Third or fourth degree perineal laceration Condition-perineal-laceration BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 47.3. Maternal Morbidity: Ruptured uterus Condition-ruptured-uterus BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 47.4. Maternal Morbidity: Unplanned hysterectomy Procedure-unplanned-hysterectomy BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 47.5. Maternal Morbidity: Admission to intensive care unit Observation-icu-admission BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 47.7. Maternal Morbidity: None of the above Observation-none-of-specified-maternal-morbidities BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 48. Newborn Medical Record Number Patient-child-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 49. Birthweight Observation-birth-weight-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 50. Obstetric Estimate of Gestation Observation-gestational-age-at-delivery-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 51. Apgar Score: Observation-apgar-score-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 52. Plurality Patient-child-vr.multipleBirth[x].extension.patient-multipleBirthTotal FHIR
2003 Revision of the U.S. Standard Certificate of Live Birth 53. If Not Single Birth - Born First, Second, Third, etc. (Specify) Patient-child-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 54.1. Abnormal Conditions of the Newborn: Assisted ventilation required immediately following delivery Procedure-assisted-ventilation-following-delivery BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 54.2. Abnormal Conditions of the Newborn: Assisted ventilation required for more than six hours Procedure-assisted-ventilation-more-than-six-hours BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 54.3. Abnormal Conditions of the Newborn: NICU admission Observation-nicu-admission BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 54.4. Abnormal Conditions of the Newborn: Newborn given surfactant replacement therapy Procedure-surfactant-replacement-therapy BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 54.5. Abnormal Conditions of the Newborn: Antibiotics received by the newborn for suspected neonatal sepsis Procedure-antibiotic-suspected-neonatal-sepsis BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 54.6 Abnormal Conditions of the Newborn: Seizure or serious neurologic dysfunction Condition-seizure BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 54.8 Abnormal Conditions of the Newborn: None of the above Observation-none-of-specified-abnormal-conditions-of-newborn BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 55. Congenital Anomalies of the Newborn Condition-congenital-anomaly-of-newborn BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 56. Was Infant Transferred Within 24 Hours Of Delivery? Encounter-birth.hospitalization.dischargeDisposition BFDR
2003 Revision of the U.S. Standard Certificate of Live Birth 57. Is Infant Living At Time of Report? Observation-infant-living-vr VRCPL
2003 Revision of the U.S. Standard Certificate of Live Birth 58. Is The Infant Being Breastfed At Discharge? Observation-infant-breastfed-at-discharge BFDR

2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births Mapping

Form Element Profile/Extension Location
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births Mother’s medical record # Patient-mother-vr VRCPL
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births Mother’s name Patient-mother-vr VRCPL
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births Child’s name/medical record # Patient-child-vr VRCPL
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 9. Number of previous live births now living Observation-number-births-now-living-vr VRCPL
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 10. Number of previous live births now dead Observation-number-births-now-dead-vr VRCPL
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 12. Number of other pregnancy outcomes Observation-number-other-pregnancy-outcomes-vr VRCPL
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 17. Date of birth Patient-child-vr VRCPL
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 18. Time of birth Patient-child-vr.birthDate.extension.patient-birthTime FHIR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 34. Order delivered in the pregnancy Patient-child-vr VRCPL
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 26.1. Characteristics of Labor and Delivery: Induction of labor Procedure-induction-of-labor BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 26.2. Characteristics of Labor and Delivery: Augmentation of labor Procedure-augmentation-of-labor BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 26.3.. Characteristics of Labor and Delivery: Steroids for fetal lung maturation Observation-steroids-fetal-lung-maturation BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 26.4. Characteristics of Labor and Delivery: Antibiotics received by the mother during labor Observation-antibiotics-during-labor BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 26.5. Characteristics of Labor and Delivery: Clinical chorioamnionitis Condition-chorioamnionitis BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 26.6. Characteristics of Labor and Delivery: Epidural or spinal anesthesia during labor Procedure-epidural-or-spinal-anesthesia BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 26.7. Characteristics of Labor and Delivery: None of the above Observation-none-of-specified-characteristics-labor-delivery BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 27.C. Method of delivery: Fetal presentation at birth Observation-fetal-presentation BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 27.D. Method of delivery: Final route and method of delivery Procedure-final-route-method-delivery BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 27.D.1. If cesarean, was a trial of labor attempted? Observation-labor-trial-attempted BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 28.1. Maternal Morbidity: Maternal transfusion Procedure-blood-transfusion BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 28.2. Maternal Morbidity: Third or fourth degree perineal laceration Condition-perineal-laceration BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 28.3. Maternal Morbidity: Ruptured uterus Condition-ruptured-uterus BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 28.4. Maternal Morbidity: Unplanned hysterectomy Procedure-unplanned-hysterectomy BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 28.5. Maternal Morbidity: Admission to intensive care unit Observation-icu-admission BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 28.6. Maternal Morbidity: None of the above Observation-none-of-specified-maternal-morbidities BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 29. Birthweight Observation-birth-weight-vr VRCPL
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 30. Obstetric estimate of gestation at delivery Observation-gestational-age-at-delivery-vr VRCPL
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 31. Sex Patient-child-vr.extension.us-core-birthsex US CORE
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 32. Apgar score Observation-apgar-score-vr VRCPL
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 36.1. Abnormal Conditions of the Newborn: Assisted ventilation required immediately following delivery Procedure-assisted-ventilation-following-delivery BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 36.2. Abnormal Conditions of the Newborn: Assisted ventilation required for more than six hours Procedure-assisted-ventilation-more-than-six-hours BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 36.3. Abnormal Conditions of the Newborn: NICU admission Observation-nicu-admission BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 36.4. Abnormal Conditions of the Newborn: Newborn given surfactant replacement therapy Procedure-surfactant-replacement-therapy BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 36.5. Abnormal Conditions of the Newborn: Antibiotics received by the newborn for suspected neonatal sepsis Procedure-antibiotic-suspected-neonatal-sepsis BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 36.6 Abnormal Conditions of the Newborn: Seizure or serious neurologic dysfunction Condition-seizure BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 36.7 Abnormal Conditions of the Newborn: None of the above Observation-none-of-specified-abnormal-conditions-of-newborn BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 37. Congenital anomalies of the newborn Condition-congenital-anomaly-of-newborn BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 38. Was infant transferred within 24 hours of delivery? Encounter-birth.hospitalization.dischargeDisposition BFDR
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 39. Is infant living at time of report? Observation-infant-living-vr VRCPL
2016 US Standard Attachment to the Facility Worksheet for the Live Birth Certificate for Multiple Births 40. Is infant being breastfed at discharge? Observation-infant-breastfed-at-discharge BFDR

2016 US Standard Facility Worksheet for the Live Birth Certificate Mapping

Form Element Profile/Extension Location
2016 US Standard Facility Worksheet for the Live Birth Certificate Mother’s medical record # Patient-mother-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate Mother’s name Patient-mother-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 1. Facility name / address Encounter-birth.us-core-location.name/address US CORE
2016 US Standard Facility Worksheet for the Live Birth Certificate 2. Facility I.D. Encounter-birth.us-core-location.identifier US CORE
2016 US Standard Facility Worksheet for the Live Birth Certificate 3. City, Town or Location of birth Patient-child-vr.extension.patient-birthPlace FHIR
2016 US Standard Facility Worksheet for the Live Birth Certificate 4. County of birth Patient-child-vr.extension.patient-birthPlace FHIR
2016 US Standard Facility Worksheet for the Live Birth Certificate 5. Place where birth occurred Encounter-birth.location.physicalType BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 5.a. Home Birth: Planned to deliver at home? Observation-planned-to-deliver-at-home BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 6. Date of first prenatal care visit Observation-date-of-first-prenatal-care-visit BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 7. Total number of prenatal care visits for this pregnancy Observation-number-prenatal-visits-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 8. Date last normal menses began Observation-last-menstrual-period-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 9. Number of previous live births now living Observation-number-births-now-living-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 10. Number of previous live births now dead Observation-number-births-now-dead-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 11. Date of last live birth Observation-date-of-last-live-birth BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 12. Number of other pregnancy outcomes Observation-number-other-pregnancy-outcomes-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 13. Date of last other pregnancy outcome Observation-date-of-last-other-pregnancy-outcome BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 14.1. Risk factors in this pregnancy: Diabetes - Prepregnancy Condition-prepregnancy-diabetes-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 14.2. Risk factors in this pregnancy: Diabetes - Gestational Condition-gestational-diabetes-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 14.3. Risk factors in this pregnancy: Hypertension - Prepregnancy Condition-prepregnancy-hypertension-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 14.4. Risk factors in this pregnancy: Hypertension - Gestational Condition-gestational-hypertension-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 14.5. Risk factors in this pregnancy: Eclampsia Condition-eclampsia-hypertension-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 14.6. Risk factors in this pregnancy: Previous preterm births Observation-previous-preterm-birth-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 14.7. Risk factors in this pregnancy: Pregnancy resulted from infertility treatment Procedure-infertility-treatment-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 14.8. Risk factors in this pregnancy: Fertility-enhancing drugs, artificial insemination or intrauterine insemination Procedure-artificial-insemination-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 14.9. Risk factors in this pregnancy: Assisted reproductive technology Procedure-assisted-fertilization-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 14.10. Risk factors in this pregnancy: previous cesarean delivery Observation-previous-cesarean-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 14.11. Risk factors in this pregnancy: None of the above Observation-none-of-specified-pregnancy-risk-factors-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 15. Infections present and/or treated during this pregnancy Condition-infection-present-during-pregnancy BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 16. Obstetric procedures Procedure-obstetric BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 17. Date of birth Patient-child-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 18. Time of birth Patient-child-vr.birthDate.extension.patient-birthTime FHIR
2016 US Standard Facility Worksheet for the Live Birth Certificate 19. Certifier’s name Practitioner-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 19. Certifier’s title Practitioner-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 20. Date certified Encounter-birth.participant:certifier.period.start BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 21. Principal source of payment for this delivery Coverage-principal-payer-for-delivery BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 22. Infant’s medical record number Patient-child-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 23. Was the mother transferred to this facility for maternal medical or fetal indications for delivery? Encounter-maternity.hospitalization.admitSource (Y if present, N if not present) BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 24. Attendant’s name Practitioner-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 24. Attendant’s title Practitioner-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 24. Attendant’s N.P.I. Practitioner-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 25. Mother’s weight at delivery Observation-mother-delivery-weight-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 26.1. Characteristics of Labor and Delivery: Induction of labor Procedure-induction-of-labor BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 26.2. Characteristics of Labor and Delivery: Augmentation of labor Procedure-augmentation-of-labor BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 26.3. Characteristics of Labor and Delivery: Steroids for fetal lung maturation Observation-steroids-fetal-lung-maturation BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 26.4. Characteristics of Labor and Delivery: Antibiotics received by the mother during labor Observation-antibiotics-during-labor BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 26.5. Characteristics of Labor and Delivery: Clinical chorioamnionitis Condition-chorioamnionitis BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 26.6. Characteristics of Labor and Delivery: Epidural or spinal anesthesia during labor Procedure-epidural-or-spinal-anesthesia BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 26.7. Characteristics of Labor and Delivery: None of the above Observation-none-of-specified-characteristics-labor-delivery BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 27.C. Method of delivery: Fetal presentation at birth Observation-fetal-presentation BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 27.D. Method of delivery: Final route and method of delivery Procedure-final-route-method-delivery BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 27.D.1. Method of delivery: If cesarean, was a trial of labor attempted? Observation-labor-trial-attempted BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 28.1. Maternal Morbidity: Maternal transfusion Procedure-blood-transfusion BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 28.2. Maternal Morbidity: Third or fourth degree perineal laceration Condition-perineal-laceration BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 28.3. Maternal Morbidity: Ruptured uterus Condition-ruptured-uterus BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 28.4. Maternal Morbidity: Unplanned hysterectomy Procedure-unplanned-hysterectomy BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 28.5. Maternal Morbidity: Admission to intensive care unit Observation-icu-admission BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 28.6. Maternal Morbidity: None of the above Observation-none-of-specified-maternal-morbidities BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 29. Birthweight Observation-birth-weight-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 30. Obstetric estimate of gestation at delivery Observation-gestational-age-at-delivery-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 31. Sex: Patient-child-vr.extension.us-core-birthsex US CORE
2016 US Standard Facility Worksheet for the Live Birth Certificate 32. Apgar score Observation-apgar-score-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 33. Plurality Patient-child-vr.multipleBirthInteger.extension.patient-multipleBirthTotal FHIR
2016 US Standard Facility Worksheet for the Live Birth Certificate 34. If not single birth, order delivered in the pregnancy Patient-child-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 35. If not single birth, specify number of infants in this delivery born alive: Observation-number-live-births-this-delivery-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 36.1. Abnormal Conditions of the Newborn: Assisted ventilation required immediately following delivery Procedure-assisted-ventilation-following-delivery BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 36.2. Abnormal Conditions of the Newborn: Assisted ventilation required for more than six hours Procedure-assisted-ventilation-more-than-six-hours BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 36.3. Abnormal Conditions of the Newborn: NICU admission Observation-nicu-admission BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 36.4. Abnormal Conditions of the Newborn: Newborn given surfactant replacement therapy Procedure-surfactant-replacement-therapy BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 36.5. Abnormal Conditions of the Newborn: Antibiotics received by the newborn for suspected neonatal sepsis Procedure-antibiotic-suspected-neonatal-sepsis BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 36.6 Abnormal Conditions of the Newborn: Seizure or serious neurologic dysfunction Condition-seizure BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 54.7 Abnormal Conditions of the Newborn: None of the above Observation-none-of-specified-abnormal-conditions-of-newborn BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 37. Congenital anomalies of the newborn Condition-congenital-anomaly-of-newborn BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 38. Was infant transferred within 24 hours of delivery? Encounter-birth.hospitalization.dischargeDisposition BFDR
2016 US Standard Facility Worksheet for the Live Birth Certificate 39. Is infant living at time of report? Observation-infant-living-vr VRCPL
2016 US Standard Facility Worksheet for the Live Birth Certificate 40. Is infant being breastfed at discharge? Observation-infant-breastfed-at-discharge BFDR

2016 US Standard Mother’s Worksheet for Child’s Birth Certificate Mapping

Form Element Profile/Extension Location
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 1. What is your current legal name? Patient-mother-vr VRCPL
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 2. What will be your baby’s legal name? Patient-child-vr VRCPL
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 3. Where do you usually live–that is–where is your household/residence located? Patient-mother-vr VRCPL
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 4. Is this household inside city limits? Patient-mother-vr VRCPL
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 5. What is your mailing address? Patient-mother-vr VRCPL
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 6. What is your date of birth? Patient-mother-vr VRCPL
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 7. In what State, U.S. territory, or foreign country were you born? Patient-mother-vr.extension.patient-birthPlace FHIR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 8. What is the highest level of schooling that you will have completed at the time of delivery? Observation-parent-education-level-vr VRCPL
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 9. Are you Spanish/Hispanic/Latina? Patient-mother-vr.extension.us-core-ethnicity US CORE
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 10. What is your race? Patient-mother-vr.extension.us-core-race US CORE
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 11. Did you receive WIC food for yourself because you were pregnant with this child? Observation-mother-received-wic-food BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 12. Did this pregnancy result from infertility treatment? Questionnaire-mothers-live-birth BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 13. What is your height? Observation-mother-height-vr VRCPL
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 14. What was your prepregnancy weight, that is, your weight immediately before you became pregnant with this child? Observation-mother-prepregnancy-weight-vr VRCPL
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 15. How many cigarettes OR packs of cigarettes did you smoke on an average day during each of the following time periods? Observation-cigarette-smoking-before-during-pregnancy BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 17. What name did you use prior to your first marriage? Patient-mother-vr VRCPL
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 18. Were you married at the time you conceived this child, at the time of birth, or at any time between conception and giving birth? Observation-mother-married-during-pregnancy BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 19. What is the current legal name of your baby’s father? RelatedPerson-father-natural-vr VRCPL
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 20. What is the father’s date of birth? RelatedPerson-father-natural-vr VRCPL
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 21. In what State, U.S. territory, or foreign country was the father born? Extension-relatedperson-birthplace-vr VRCPL
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 22. What is the highest level of schooling that the father will have completed at the time of delivery? Observation-parent-education-level-vr VRCPL
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 23. Is the father Spanish/Hispanic/Latino? RelatedPerson-father-natural-vr.extension.us-core-ethnicity US CORE
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 24. What is the father’s race? RelatedPerson-father-natural-vr.extension.us-core-race US CORE
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 25a. What is your Social Security Number? Patient-mother-vr VRCPL
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 25b. What is the father’s Social Security Number? RelatedPerson-father-natural-vr VRCPL
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 26a. Do you want a Social Security Number issued for your baby? Observation-ssn-requested-for-child BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 26b. I request that the Social Security Administration assign a Social Security number to the child named on this form and authorize the State to provide the Social Security Administration with the information from this form which is needed to assign a number. Questionnaire-mothers-live-birth BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 27a. If other than the mother, what is the name of the person providing information for this worksheet? Questionnaire-mothers-live-birth BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 27b. What is your relationship to the baby’s mother? Questionnaire-mothers-live-birth BFDR

2003 Revision of the U.S. Standard Report of Fetal Death Mapping

Form Element Profile/Extension Location
2003 Revision of the U.S. Standard Report of Fetal Death Local File No. Composition-provider-fetal-death-report.extension.Extension-fetal-death-local-file-number BFDR
2003 Revision of the U.S. Standard Report of Fetal Death State File Number Composition-provider-fetal-death-report.extension.Extension-fetal-death-report-number BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 1. Name of Fetus Patient-decedent-fetus-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 2. Time of Delivery Patient-decedent-fetus-vr.birthDate.extension.patient-birthTime FHIR
2003 Revision of the U.S. Standard Report of Fetal Death 3. Sex Patient-decedent-fetus-vr.extension.us-core-birthsex US CORE
2003 Revision of the U.S. Standard Report of Fetal Death 4. Date of Delivery Patient-decedent-fetus-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 5a. City, Town, or Location of Delivery Patient-decedent-fetus-vr.extension.patient-birthPlace FHIR
2003 Revision of the U.S. Standard Report of Fetal Death 5b. Zip Code of Delivery Patient-decedent-fetus-vr.extension.patient-birthPlace FHIR
2003 Revision of the U.S. Standard Report of Fetal Death 6. County of Delivery Patient-decedent-fetus-vr.extension.patient-birthPlace FHIR
2003 Revision of the U.S. Standard Report of Fetal Death 7. Place Where Delivery Occurred Encounter-maternity.location.physicalType BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 7.a. Home Birth: Planned to deliver at home? Observation-planned-to-deliver-at-home BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 8. Facility Name / address Encounter-maternity.location.location.us-core-location.identifier US CORE
2003 Revision of the U.S. Standard Report of Fetal Death 9. Facility Id Encounter-maternity.location.location.us-core-location.identifier US CORE
2003 Revision of the U.S. Standard Report of Fetal Death 10a. Mother’s Current Legal Name Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 10b. Mother’s Date of Birth Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 10c. Mother’s Name Prior to First Marriage Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 10d. Mother’s Birthplace Patient-mother-vr.extension.patient-birthPlace FHIR
2003 Revision of the U.S. Standard Report of Fetal Death 11a. Residence of Mother-State Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 11b. Residence of Mother-County Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 11c. Residence of Mother-City, Town, Or Location Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 11d. Residence of Mother-Street And Number Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 11e. Residence of Mother-Apt. No. Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 11f. Residence of Mother-Zip Code Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 11g. Residence of Mother-Inside City Limits? Patient-mother-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 12a. Father’s Current Legal Name RelatedPerson-father-natural-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 12b. Father’s Date of Birth RelatedPerson-father-natural-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 12c. Father’s Birthplace Extension-relatedperson-birthplace-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 13. Method of Disposition: Observation-method-of-disposition BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 14. Attendant’s Name Practitioner-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 14. Attendant’s Title Practitioner-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 14. Attendant’s NPI Practitioner-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 15. Name Of Person Completing Report Practitioner-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 15. Title Of Person Completing Report Practitioner-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 16. Date Report Completed Composition-provider-fetal-death-report.date BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 17. Date Received By Registrar Composition-provider-fetal-death-report.extension.Extension-date-received-by-registrar BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 18a. Initiating Cause/Condition Condition-fetal-death-cause-or-condition BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 18b. Other Significant Causes or Conditions Condition-fetal-death-other-cause-or-condition BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 18c. Weight of Fetus Observation-birth-weight-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 18d. Obstetric Estimate of Gestation at Delivery Observation-gestational-age-at-delivery-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 18e. Estimated Time of Fetal Death Observation-estimated-fetal-death-time-point BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 18f. Was an Autopsy Performed? Observation-autopsy-performed-indicator-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 18g. Was a Histological Placental Examination Performed? Observation-histological-placental-exam-performed BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 18h. Were Autopsy or Histological Placental Examination Results Used in Determining the Cause of Fetal Death? Observation-autopsy-histological-exam-results-used BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 19. Mother’s Education Observation-parent-education-level-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 20. Mother of Hispanic Origin? Patient-mother-vr.extension.us-core-ethnicity US CORE
2003 Revision of the U.S. Standard Report of Fetal Death 21. Mother’s Race Patient-mother-vr.extension.us-core-race US CORE
2003 Revision of the U.S. Standard Report of Fetal Death 22. Mother Married? Observation-mother-married-during-pregnancy BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 23a. Date of First Prenatal Care Visit Observation-date-of-first-prenatal-care-visit BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 24. Total Number of Prenatal Visits For This Pregnancy Observation-number-prenatal-visits-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 25. Mother’s Height Observation-mother-height-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 26. Mother’s Prepregnancy Weight Observation-mother-prepregnancy-weight-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 28. Did Mother Get WIC Food For Herself During This Pregnancy? Observation-mother-received-wic-food BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 29a. Number of Previous Live Births: Now Living Number Observation-number-births-now-living-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 29b. Number of Previous Live Births: Now Dead Number Observation-number-births-now-dead-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 29c. Date of Last Live Birth Observation-date-of-last-live-birth BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 31. Cigarette Smoking Before and During Pregnancy Observation-cigarette-smoking-before-during-pregnancy BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 32. Date Last Normal Menses Began Observation-last-menstrual-period-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 33. Plurality Observation-plurality-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 34. If Not Single Birth-Born First, Second, Third, etc. Patient-decedent-fetus-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 36.1. Risk factors in this pregnancy: Diabetes - Prepregnancy Condition-prepregnancy-diabetes-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 36.2. Risk factors in this pregnancy: Diabetes - Gestational Condition-gestational-diabetes-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 36.3. Risk factors in this pregnancy: Hypertension - Prepregnancy Condition-prepregnancy-hypertension-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 36.4. Risk factors in this pregnancy: Hypertension - Gestational Condition-gestational-hypertension-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 36.5. Risk factors in this pregnancy: Eclampsia Condition-eclampsia-hypertension-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 36.8. Risk factors in this pregnancy: Pregnancy resulted from infertility treatment Procedure-infertility-treatment-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 36.9. Risk factors in this pregnancy: Fertility-enhancing drugs, artificial insemination or intrauterine insemination Procedure-artificial-insemination-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 36.10. Risk factors in this pregnancy: Assisted reproductive technology Procedure-assisted-fertilization-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 36.11. Risk factors in this pregnancy: Previous cesarean delivery Observation-previous-cesarean-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 36.12. Risk factors in this pregnancy: None of the above Observation-none-of-specified-pregnancy-risk-factors-vr VRCPL
2003 Revision of the U.S. Standard Report of Fetal Death 38.C. Method of Delivery: Fetal presentation at delivery Observation-fetal-presentation BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 38.D. Method of Delivery: Final route and method of delivery Procedure-final-route-method-delivery BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 38.D.1. Method of Delivery: If cesarean, was a trial of labor attempted? Observation-labor-trial-attempted BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 39.3. Maternal Morbidity: Ruptured uterus Condition-ruptured-uterus BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 39.5. Maternal Morbidity: Admission to intensive care unit Observation-icu-admission BFDR
2003 Revision of the U.S. Standard Report of Fetal Death 39.7. Maternal Morbidity: None of the above Observation-none-of-specified-maternal-morbidities BFDR

2019 US Standard Facility Worksheet for the Report of Fetal Death Mapping

Form Element Profile/Extension Location
2019 US Standard Facility Worksheet for the Report of Fetal Death Patient’s medical record # Patient-mother-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death Patient’s name Patient-mother-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 1. Facility name Encounter-maternity.location.location.us-core-location.name US CORE
2019 US Standard Facility Worksheet for the Report of Fetal Death 1. Facility address Encounter-maternity.location.location.us-core-location.address US CORE
2019 US Standard Facility Worksheet for the Report of Fetal Death 2. Facility I.D. (National Provider Identifier) Encounter-maternity.location.location.us-core-location.identifier US CORE
2019 US Standard Facility Worksheet for the Report of Fetal Death 3. City, Town or Location of delivery Patient-decedent-fetus-vr.extension.patient-birthPlace FHIR
2019 US Standard Facility Worksheet for the Report of Fetal Death 4. County of delivery Patient-decedent-fetus-vr.extension.patient-birthPlace FHIR
2019 US Standard Facility Worksheet for the Report of Fetal Death 5. Place of delivery Encounter-maternity.location.physicalType BFDR
2019 US Standard Facility Worksheet for the Report of Fetal Death 5.a. Planned to deliver at home Observation-planned-to-deliver-at-home BFDR
2019 US Standard Facility Worksheet for the Report of Fetal Death 6. Date of first prenatal care visit Observation-date-of-first-prenatal-care-visit BFDR
2019 US Standard Facility Worksheet for the Report of Fetal Death 7. Date last normal menses began: Observation-last-menstrual-period-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 8. Number of previous live births now living Observation-number-births-now-living-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 9. Number of previous live births now dead Observation-number-births-now-dead-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 10. Date of last live birth Observation-date-of-last-live-birth BFDR
2019 US Standard Facility Worksheet for the Report of Fetal Death 11.1. Risk factors in this pregnancy: Diabetes - Prepregnancy Condition-prepregnancy-diabetes-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 11.2. Risk factors in this pregnancy: Diabetes - Gestational Condition-gestational-diabetes-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 11.3. Risk factors in this pregnancy: Hypertension - Prepregnancy Condition-prepregnancy-hypertension-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 11.4. Risk factors in this pregnancy: Hypertension - Gestational Condition-gestational-hypertension-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 11.5. Risk factors in this pregnancy: Eclampsia Condition-eclampsia-hypertension-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 11.6. Risk factors in this pregnancy: Pregnancy resulted from infertility treatment Procedure-infertility-treatment-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 11.7. Risk factors in this pregnancy: Fertility-enhancing drugs, artificial insemination or intrauterine insemination Procedure-artificial-insemination-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 11.8. Risk factors in this pregnancy: Assisted reproductive technology Procedure-assisted-fertilization-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 11.9. Risk factors in this pregnancy: previous cesarean delivery Observation-previous-cesarean-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 11.10. Risk factors in this pregnancy: None of the above Observation-none-of-specified-pregnancy-risk-factors-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 12. Date of delivery Patient-decedent-fetus-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 13. Time of delivery Patient-decedent-fetus-vr.extension.patient-birthTime FHIR
2019 US Standard Facility Worksheet for the Report of Fetal Death 14. Name of person completing report Practitioner-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 14. Title of person completing report Practitioner-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 15. Date report completed Composition-provider-fetal-death-report.date BFDR
2019 US Standard Facility Worksheet for the Report of Fetal Death 16. Attendant’s name Practitioner-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 16. Attendant’s title Practitioner-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 16. Attendant’s N.P.I. Practitioner-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 17.A. Method of Delivery: Fetal presentation at delivery Observation-fetal-presentation BFDR
2019 US Standard Facility Worksheet for the Report of Fetal Death 17.B. Method of Delivery: Final route and method of delivery Procedure-final-route-method-delivery BFDR
2019 US Standard Facility Worksheet for the Report of Fetal Death 18.1. Maternal Morbidity: Ruptured uterus Condition-ruptured-uterus BFDR
2019 US Standard Facility Worksheet for the Report of Fetal Death 18.2. Maternal Morbidity: Admission to intensive care unit Observation-icu-admission BFDR
2019 US Standard Facility Worksheet for the Report of Fetal Death 18.3. Maternal Morbidity: None of the above Observation-none-of-specified-maternal-morbidities BFDR
2019 US Standard Facility Worksheet for the Report of Fetal Death 19. Weight of fetus Observation-birth-weight-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 20. Obstetric estimate of gestation at delivery Observation-gestational-age-at-delivery-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 21. Sex Patient-decedent-fetus-vr.extension.us-core-birthsex US CORE
2019 US Standard Facility Worksheet for the Report of Fetal Death 22. Plurality Patient-decedent-fetus-vr.multipleBirth[x].extension.patient-multipleBirthTotal FHIR
2019 US Standard Facility Worksheet for the Report of Fetal Death 23. If not single delivery, order delivered in the pregnancy Patient-decedent-fetus-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 24. If not single delivery, specify number of fetal losses in this delivery Observation-number-fetal-deaths-this-delivery-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 25. Method of Disposition Observation-method-of-disposition BFDR
2019 US Standard Facility Worksheet for the Report of Fetal Death 26. Initiating Cause/Condition Condition-fetal-death-cause-or-condition BFDR
2019 US Standard Facility Worksheet for the Report of Fetal Death 27. Other Significant Causes or Conditions Condition-fetal-death-other-cause-or-condition BFDR
2019 US Standard Facility Worksheet for the Report of Fetal Death 28. Was an autopsy performed? Observation-autopsy-performed-indicator-vr VRCPL
2019 US Standard Facility Worksheet for the Report of Fetal Death 29. Was a histological placental examination performed? Observation-histological-placental-exam-performed BFDR
2019 US Standard Facility Worksheet for the Report of Fetal Death 30. Were autopsy or histological placental examination results used in determining the cause of fetal death? Observation-autopsy-histological-exam-results-used BFDR
2019 US Standard Facility Worksheet for the Report of Fetal Death 31. Estimated time of fetal death Observation-estimated-fetal-death-time-point BFDR

2019 US Standard Patient’s Worksheet for the Report of Fetal Death Mapping

Form Element Profile/Extension Location
2019 US Standard Patient’s Worksheet for the Report of Fetal Death Patient’s Medical Record # Patient-mother-vr VRCPL
2019 US Standard Patient’s Worksheet for the Report of Fetal Death Patient’s Name Patient-mother-vr VRCPL
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 1. Would you like to name the child? Patient-decedent-fetus-vr VRCPL
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 2. What is your current legal name? Patient-mother-vr VRCPL
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 3. Where do you usually live (household/residence location)? Patient-mother-vr VRCPL
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 4. Is this household inside city limits? Patient-mother-vr VRCPL
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 5. What is your mailing address? Patient-mother-vr VRCPL
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 6. What is your date of birth? Patient-mother-vr VRCPL
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 7. In what State, U.S. territory, or foreign country were you born? Patient-mother-vr.extension.patient-birthPlace FHIR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 8. What is the highest level of schooling that you have completed at the time of delivery? Observation-parent-education-level-vr VRCPL
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 9. Are you Spanish/Hispanic/Latina? Patient-mother-vr.extension.us-core-ethnicity US CORE
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 10. What is your race? Patient-mother-vr.extension.us-core-race US CORE
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 11. What is the current legal name of your baby’s father? RelatedPerson-father-natural-vr VRCPL
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 12. What is the father’s date of birth? RelatedPerson-father-natural-vr VRCPL
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 13. In what State, U.S. territory, or foreign country was the father born? Extension-relatedperson-birthplace-vr VRCPL
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 14. Did you receive WIC (Women, Infants & Children) food for yourself during this pregnancy? Observation-mother-received-wic-food BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 15. What is your height? Observation-mother-height-vr VRCPL
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 16. What was your prepregnancy weight? Observation-mother-prepregnancy-weight-vr VRCPL
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 17. How many cigarettes OR packs of cigarettes did you smoke on an average day during each time period? Observation-cigarette-smoking-before-during-pregnancy BFDR

2016 US Standard Mother’s Worksheet for Child’s Birth Certificate Questionnaire Mapping

Form Element Questionnaire Location
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 1. What is your current legal name? Questionnaire-mothers-live-birth.item.linkId=mother-current-legal-name BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 2. What will be your baby’s legal name? Questionnaire-mothers-live-birth.item.linkId=child-name BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 3. Where do you usually live–that is–where is your household/residence located? Questionnaire-mothers-live-birth.item.linkId=mother-address BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 4. Is this household inside city limits? Questionnaire-mothers-live-birth.item.linkId=inside-city-limits BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 5. What is your mailing address? Questionnaire-mothers-live-birth.item.linkId=mother-mail BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 6. What is your date of birth? Questionnaire-mothers-live-birth.item.linkId=mother-dob BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 7. In what State, U.S. territory, or foreign country were you born? Questionnaire-mothers-live-birth.item.linkId=mother-birthplace BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 8. What is the highest level of schooling that you will have completed at the time of delivery? Questionnaire-mothers-live-birth.item.linkId=mother-education BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 9. Are you Spanish/Hispanic/Latina? Questionnaire-mothers-live-birth.item.linkId=mother-ethnicity BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 10. What is your race? Questionnaire-mothers-live-birth.item.linkId=mother-race BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 11. Did you receive WIC food for yourself because you were pregnant with this child? Questionnaire-mothers-live-birth.item.linkId=receive-wic BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 12. Did this pregnancy result from infertility treatment? Questionnaire-mothers-live-birth.item.linkId=infertility-treatment BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 13. What is your height? Questionnaire-mothers-live-birth.item.linkId=mothers-height BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 14. What was your prepregnancy weight, that is, your weight immediately before you became pregnant with this child? Questionnaire-mothers-live-birth.item.linkId=mothers-prepregnancy-weight BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 15. How many cigarettes OR packs of cigarettes did you smoke on an average day during each of the following time periods? Questionnaire-mothers-live-birth.item.linkId=mothers-smoking BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 17. What name did you use prior to your first marriage? Questionnaire-mothers-live-birth.item.linkId=mother-prior-name BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 18. Were you married at the time you conceived this child, at the time of birth, or at any time between conception and giving birth? Questionnaire-mothers-live-birth.item.linkId=married-conception BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 19. What is the current legal name of your baby’s father? Questionnaire-mothers-live-birth.item.linkId=father-current-legal-name BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 20. What is the father’s date of birth? Questionnaire-mothers-live-birth.item.linkId=father-dob BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 21. In what State, U.S. territory, or foreign country was the father born? Questionnaire-mothers-live-birth.item.linkId=father-birthplace BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 22. What is the highest level of schooling that the father will have completed at the time of delivery? Questionnaire-mothers-live-birth.item.linkId=father-education BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 23. Is the father Spanish/Hispanic/Latino? Questionnaire-mothers-live-birth.item.linkId=father-ethnicity BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 24. What is the father’s race? Questionnaire-mothers-live-birth.item.linkId=father-race BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 25a. What is your Social Security Number? Questionnaire-mothers-live-birth.item.linkId=mother-ssn BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 25b. What is the father’s Social Security Number? Questionnaire-mothers-live-birth.item.linkId=father-ssn BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 26a. Do you want a Social Security Number issued for your baby? Questionnaire-mothers-live-birth.item.linkId=baby-ssn BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 26b. I request that the Social Security Administration assign a Social Security number to the child named on this form and authorize the State to provide the Social Security Administration with the information from this form which is needed to assign a number. Questionnaire-mothers-live-birth.item.linkId=baby-ssn-sig BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 27a. If other than the mother, what is the name of the person providing information for this worksheet? Questionnaire-mothers-live-birth.item.linkId=informant-name BFDR
2016 US Standard Mother’s Worksheet for Child’s Birth Certificate 27b. What is your relationship to the baby’s mother? Questionnaire-mothers-live-birth.item.linkId=informant-relationship BFDR

2019 US Standard Patient’s Worksheet for the Report of Fetal Death Questionnaire Mapping

Form Element Questionnaire Location
2019 US Standard Patient’s Worksheet for the Report of Fetal Death Patient’s Medical Record # Questionnaire-patients-fetal-death.source BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death Patient’s Name Questionnaire-patients-fetal-death.source BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 1. Would you like to name the child? Questionnaire-patients-fetal-death.item.linkId=child-name BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 2. What is your current legal name? Questionnaire-patients-fetal-death.item.linkId=mother-current-legal-name BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 3. Where do you usually live (household/residence location)? Questionnaire-patients-fetal-death.item.linkId=mother-address BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 4. Is this household inside city limits? Questionnaire-patients-fetal-death.item.linkId=inside-city-limits BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 5. What is your mailing address? Questionnaire-patients-fetal-death.item.linkId=mother-mail BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 6. What is your date of birth? Questionnaire-patients-fetal-death.item.linkId=mother-dob BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 7. In what State, U.S. territory, or foreign country were you born? Questionnaire-patients-fetal-death.item.linkId=mother-birthplace BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 8. What is the highest level of schooling that you have completed at the time of delivery? Questionnaire-patients-fetal-death.item.linkId=mother-education BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 9. Are you Spanish/Hispanic/Latina? Questionnaire-patients-fetal-death.item.linkId=mother-ethnicity BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 10. What is your race? Questionnaire-patients-fetal-death.item.linkId=mother-race BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 11. What is the current legal name of your baby’s father? Questionnaire-patients-fetal-death.item.linkId=father-current-legal-name BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 12. What is the father’s date of birth? Questionnaire-patients-fetal-death.item.linkId=father-dob BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 13. In what State, U.S. territory, or foreign country was the father born? Questionnaire-patients-fetal-death.item.linkId=father-birthplace BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 14. Did you receive WIC (Women, Infants & Children) food for yourself during this pregnancy? Questionnaire-patients-fetal-death.item.linkId=receive-wic BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 15. What is your height? Questionnaire-patients-fetal-death.item.linkId=mothers-height BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 16. What was your prepregnancy weight? Questionnaire-patients-fetal-death.item.linkId=mothers-prepregnancy-weight BFDR
2019 US Standard Patient’s Worksheet for the Report of Fetal Death 17. How many cigarettes OR packs of cigarettes did you smoke on an average day during each time period? Questionnaire-patients-fetal-death.item.linkId=mothers-smoking BFDR