The CDC U.S. Standard Certificate of Live Birth form is a crucial document designed to officially register a child's birth in the United States. This form captures essential information, including details about the child, the parents, and the circumstances of the birth. For parents looking to ensure their child's birth is properly documented and recognized, clicking the button below to fill out the form is an essential next step.
Welcome to an intricate exploration of a document that marks one of the most significant events in human life: the birth of a child. The CDC U.S. Standard Certificate of Live Birth form is more than just a piece of paper; it serves as the first legal recognition of a person's existence, effectively opening the door to a multitude of rights and responsibilities. This document meticulously records essential details including the newborn's identity, parentage, and the circumstances of birth. In addition to its fundamental role in acknowledging an individual's entry into the world, this certificate plays a pivotal part in health and statistical analyses, contributing to a wide array of research aimed at improving public health policies and practices. Navigating through its sections, one can uncover the precision with which it captures data, designed to ensure accuracy and uniformity across the United States. Serving multiple purposes, from legal documentation to vital statistics compilation, the CDC U.S. Standard Certificate of Live Birth form encapsulates a momentous occasion with far-reaching implications for both the individual and society at large.
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.
After the joyous event of a child's birth, properly documenting this occurrence is crucial. The CDC U.S. Standard Certificate of Live Birth serves as the official record of a new life, ensuring the child's legal recognition, and it is necessary for many administrative processes in their future. Filling out this form accurately is essential for the correct recording of birth information, which impacts a wide range of services and rights. To help ensure that all necessary information is captured correctly and submitted properly, follow these step-by-step instructions.
By carefully completing each step, you will facilitate the official recognition of the child's entry into the world and lay the groundwork for their identity and rights. Remember, the details entered on the Certificate of Live Birth are used for vital records, so accuracy and thoroughness are paramount.
The CDC U.S. Standard Certificate of Live Birth form is an official document used across the United States to record the details of a person's birth. It includes important information such as the name of the child, date and place of birth, as well as details about the parents. This form is vital for legal identification, obtaining a passport, enrolling in school, and more.
To obtain a CDC U.S. Standard Certificate of Live Birth form, contact the vital records office in the state or territory where the birth occurred. You can usually request a copy in person, by mail, or online, although the available methods and the required fees can vary between states.
The Certificate of Live Birth is typically filled out by a combination of hospital staff, parents, and/or a midwife or physician who attended the birth. The medical professional is responsible for completing the medical information about the birth, while the parents provide personal demographic details.
Filing the form itself at the time of birth usually does not incur a fee. However, obtaining a certified copy of the form later from the vital records office often requires payment of a fee. This fee varies by state and sometimes by county within the state.
Yes, names on the Certificate of Live Birth can be changed, but the process varies by state. Changes typically require legal documentation such as a court order, marriage certificate, or adoption papers, along with a completed application and possibly a fee. Contact the vital records office in the state where the birth occurred for specific requirements.
The time it takes to receive a certified copy can vary greatly by state and the method used to request the copy (in person, by mail, online). Generally, it might take anywhere from a few days to several weeks. Expedited services may be available for an additional fee.
Yes, you can obtain multiple certified copies of the Certificate of Live Birth. Each copy will require payment of a separate fee. Having multiple copies can be useful for various legal and identification purposes.
If you find an error on the Certificate of Live Birth, you should contact the vital records office in the state where the birth was recorded. You will likely need to provide proof of the correct information and fill out a form to make the correction. There may be a fee for this service.
Yes, the Certificate of Live Birth serves as the official birth record and is considered a birth certificate. Once it is filed with the vital records office, a certified copy can be requested for legal and identification purposes. The terms "Certificate of Live Birth" and "birth certificate" are often used interchangeably.
Filling out the CDC U.S. Standard Certificate of Live Birth form is an important step in ensuring that a newborn's entry into the world is officially recorded. However, it's common for people to make mistakes during this process. Recognizing and avoiding these errors can save time and help ensure the form is processed smoothly. Here are ten mistakes commonly made:
Not double-checking for typos or spelling errors, especially in names and dates. This can lead to issues with future legal documents.
Leaving sections blank that should be filled out. Even if a question seems not applicable, it's important to respond with "N/A" or "None" rather than leaving it empty.
Failing to use the mother's full legal name. The form requires the name listed on the mother's legal documents, not nicknames or shortened versions.
Incorrectly listing the city of birth. It should be the city where the birth occurred, not necessarily the city where the family lives.
Missing signatures. Both parents, if available, need to sign the form. Skipping this step can invalidate the document.
Mixing up maternal and paternal information. It's crucial to place each parent's details in the correct section to avoid confusion.
Forgetting to list the time of birth. This detail is often overlooked but is essential for accurate records.
Incorrectly formatted social security numbers or leaving them out. This can delay the issuance of the child’s social security card.
Not using the mother's maiden name where specified. The form differentiates between current name and maiden name for clarity.
Overlooking the need to fill out additional state-specific sections. Some states require extra information not covered by the federal form.
When filling out the Certificate of Live Birth, taking the time to review each section thoroughly can prevent these common mistakes. Attention to detail ensures that the document reflects accurate and complete information right from the start, facilitating a smoother process for all involved.
The Centers for Disease Control and Prevention (CDC) U.S. Standard Certificate of Live Birth is an essential document used to officially record the occurrence of a birth within the United States. This form captures critical information, including the infant's name, time and place of birth, parentage, and other vital statistics. Accompanying this fundamental certificate, several other forms and documents are frequently utilized to ensure a comprehensive documentation process of a new birth. These documents serve various purposes, from ensuring the child's eligibility for government benefits to establishing parental rights.
Each of these documents plays a unique role in safeguarding the health, identity, and rights of the newborn. They are integral to the administrative process that follows the joyous event of childbirth. Collectively, they provide a framework that supports the well-being and future opportunities for the child, ranging from health care access to educational and governmental services. Parents and guardians are encouraged to familiarize themselves with these forms and documents to ensure a smooth transition into parenthood and the early stages of their child’s life.
Death Certificate: Similar to the Certificate of Live Birth, the Death Certificate is an official document issued to certify a person's death. It includes personal details such as name, age, and cause of death, mirroring the Certificate of Live Birth's role in documenting key life events.
Marriage Certificate: This document formally records the union between two individuals, comparable to how the Certificate of Live Birth records the event of a person's birth. It contains identities, dates, and places, cementing a significant legal and personal milestone.
Divorce Decree: While documenting the dissolution of a marriage rather than the beginning of a life, a Divorce Decree is similar in that it is an official record of a significant life change, detailing the parties involved and the date the event occurred.
Adoption Certificate: The Adoption Certificate replaces the original birth certificate for an adopted child, listing the adoptive parents as the child's legal parents. This parallels the Certificate of Live Birth's role in establishing legal identity and family ties.
Passport: A Passport is an identity document that is necessary for international travel. Like the Certificate of Live Birth, it validates the holder’s personal details, such as name, date of birth, and place of birth, proving their nationality.
Social Security Card: Issued by the government, this card is essential for accessing social security benefits, opening bank accounts, and obtaining employment in the U.S. It is linked to a unique number that identifies individuals, akin to how the Certificate of Live Birth documents one's entry into the world.
Driver’s License: A Driver’s License serves as a legal permission to operate a vehicle as well as a common form of identification. It includes personal information like the Certificate of Live Birth, such as date of birth and address.
Naturalization Certificate: This certificate is issued to a new citizen of a country, proving they have completed the naturalization process. Like the Certificate of Live Birth, it is a pivotal document that confirms an individual's identity and citizenship status.
Filling out the CDC U.S. Standard Certificate of Live Birth form requires attention to detail and accuracy to ensure that the birth record accurately reflects the vital information of the newborn. Below are essential dos and don'ts to consider when completing this form:
Do:
Don't:
Many people have misconceptions about the CDC U.S. Standard Certificate of Live Birth form. Understanding the truth behind these common misunderstandings can help clarify the form's purpose and importance.
It's just a birth certificate. A common misconception is that the CDC U.S. Standard Certificate of Live Birth form and a birth certificate are one and the same. In reality, the form is a detailed document filled out at the time of birth that contains medical and demographic information. It is used to create the official birth certificate, which is a summary document used for legal identity purposes.
Anyone can access the full form. Many people believe that the Standard Certificate of Live Birth form is a public record accessible to anyone. However, access to the detailed information contained within is restricted by law to protect privacy. Only certain persons and entities with a legal right can access the full document.
It's only used for statistical purposes. While it's true that the form is used for gathering public health statistics, its purpose extends beyond that. It also establishes a legal record of birth, citizenship, and parentage, serving as a foundational document for legal identity.
The information on the form never changes. There's a misconception that once the Live Birth form is submitted, the information on it is set in stone. However, amendments can be made to correct or update certain information, under specific legal provisions and procedures.
It determines your Social Security eligibility. Some people mistakenly believe that the form directly affects eligibility for a Social Security number. In fact, the form serves as supporting documentation in the Social Security number application process but does not, in itself, determine eligibility.
It's standardized across all states. While the CDC provides a U.S. Standard Certificate of Live Birth form model, each state may adapt the form according to its specific statutes and needs. This results in variations in the form from one state to another, though they all capture a core set of information.
Only births in hospitals are recorded on the form. Many believe that only hospital births are documented with a Standard Certificate of Live Birth form. However, any birth that occurs within the United States, regardless of the setting, is legally required to be reported and documented using this form or a state equivalent.
Understanding these facts helps demystify the legal and statistical uses of the CDC U.S. Standard Certificate of Live Birth form, acknowledging its role in both public health and personal documentation.
The U.S. Standard Certificate of Live Birth is an essential document that serves as the primary record of a person's birth. Proper completion and understanding of this form are crucial for ensuring the accuracy of vital statistics and facilitating various legal and personal processes throughout a person’s life. Here are key takeaways regarding this form:
Remember, this form is more than a certificate; it's a life-long document that will be referred to time and again for various purposes. Taking the time to accurately complete and promptly file the Certificate of Live Birth will help avoid complications in the future.
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