The CDC U.S. Standard Certificate of Live Birth form serves as the foundational document for officially registering a birth in the United States. Its meticulous design captures a wide range of information, from basic demographics of the child and parents to specific health-related data from the time of birth. This form plays a critical role in both legal identification processes and public health analytics.
The journey of documenting a new life in the United States begins with the CDC U.S. Standard Certificate of Live Birth form, a pivotal document that lays the foundational brick for an individual's identity paperwork. This comprehensive form is designed to capture essential details about the newborn, including but not limited to, date and place of birth, parentage, and medical information related to the birth process. It serves multiple purposes, acting not only as a legal record of birth but also as a crucial source of data for public health officials tracking trends in birth rates, infant health, and other vital statistics. The precision and accuracy required in filling out the form highlight its significance in ensuring the child's rights and access to services are safeguarded right from the start. Its meticulous design, facilitated by the Centers for Disease Control and Prevention (CDC), underscores the effort to maintain uniformity and reliability in birth documentation across the nation, enabling a streamlined approach to data collection and analysis which, in turn, supports health policy development and program planning aimed at improving maternal and infant health outcomes.
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 a child is born in the United States, a Certificate of Live Birth form needs to be filled out. This document records the details of the birth and is essential for establishing identity, citizenship, and for accessing various services and benefits throughout the person’s life. Completing the form accurately is crucial, as it serves as a primary document for legal identification. The process can be straightforward if you follow the steps carefully.
After filling out the form, it should be submitted to the designated local or state vital records office. They will review the form, and upon approval, will issue an official birth certificate. This document will then serve as a critical piece of identification for the child. It's advised to request multiple certified copies, as they will be needed for different purposes throughout the child’s life, such as enrollment in school, obtaining a passport, or verifying identity for legal reasons.
What is the CDC U.S. Standard Certificate of Live Birth?
The CDC U.S. Standard Certificate of Live Birth is a document issued to officially register a child's birth in the United States. This form captures detailed information about the birth itself, the child, the parents, and other demographic data. It serves as a vital record that is used for various legal, personal, and public health purposes.
How is the CDC U.S. Standard Certificate of Live Birth form completed?
Typically, the form is completed by hospital or birth center staff where the birth occurs, with information provided by the parents and attending healthcare providers. For home births or those happening outside of institutional settings, it's often the responsibility of a midwife, attending physician, or the parents themselves to ensure the form is filled out accurately and submitted to the appropriate local or state vital records office.
What information is required on this form?
The form requires detailed information including but not limited to the child’s name, time and place of birth, parents’ names, addresses, and birthplaces, as well as medical information related to the pregnancy and birth. Also, it collects data on the newborn's health and any procedures performed during delivery.
Why is the CDC U.S. Standard Certificate of Live Birth important?
This certificate is essential for several reasons. It legally establishes a person's identity, nationality, and age. It's also used to calculate vital statistics, which help inform public health policies and programs. Additionally, individuals need a certified copy of their birth certificate to obtain a social security number, passport, and driver’s license, and to enroll in school or access certain government services.
Where should the completed form be submitted?
Once completed, the form should be submitted to the local or state vital records office, typically within a few days to weeks of the birth, depending on state laws. This timely submission ensures the birth is officially registered. The vital records office then issues certified copies of the birth certificate upon request.
How can one obtain a certified copy of the CDC U.S. Standard Certificate of Live Birth?
To obtain a certified copy, a request must be made to the vital records office of the state or locality where the birth occurred. This usually involves submitting a completed application form, paying a fee, and providing a valid form of identification. Policies and procedures can vary by jurisdiction, so contacting the specific office directly for instructions is advisable.
Is there a fee to register a birth or obtain a certified birth certificate?
While there is usually no fee to register a birth, obtaining a certified copy of a birth certificate does typically require payment of a fee. This fee varies by state and sometimes by municipality within states. For the most accurate and up-to-date fee schedule, it's recommended to consult the website or customer service line of the local vital records office where the birth was registered.
The CDC U.S. Standard Certificate of Live Birth form is a critical document, serving as the official record of a new individual's entry into the world. Completing this document accurately is essential, not only for governmental record-keeping but also for personal identification, citizenship, and future benefits qualifications. Yet, mistakes can and do happen. Here are nine common errors individuals might make when filling out this form:
Not double-checking for typos or misspellings, especially in names. Such errors can lead to significant complications in legal documentation and identity verification processes later in life.
Failing to use the full legal name of the child, which is essential for consistency across governmental and educational records.
Skipping questions or leaving fields blank that require an answer. Every field on the form has a purpose, whether it's immediately apparent or not.
Inaccurately reporting the place of birth. This location becomes part of the child's permanent record and may affect citizenship or residency status.
Miscalculating dates, such as the date of the birth or parental ages, which can impact demographic data and the child's future eligibility for certain programs or benefits.
Omitting the proper documentation for parents not biologically related to the child, such as in cases of adoption or surrogacy, which can lead to legal complexities.
Incorrectly listing parental information, whether due to unconventional family structures, misinterpretation of the form's requirements, or typographical errors.
Forgetting to include the attending physician's or midwife's accurate and complete information, which is necessary for validating the birth's medical oversight.
Delaying the submission of the form beyond the state's deadline, risking fines or delays in obtaining a Social Security number for the child.
To ensure the accuracy and completeness of the U.S. Standard Certificate of Live Birth, individuals are urged to:
By avoiding these common errors, parents and guardians can ensure their child's entry into the world is documented accurately and securely, laying a strong foundation for their future interactions with societal institutions.
When a new baby comes into the world, it's a time of celebration and a flurry of activity. Beyond moments of joy, there are practical matters to attend to, one of them being paperwork. The CDC U.S. Standard Certificate of Live Birth is a crucial document, recording a child's entry into the world. However, this form doesn't stand alone. Several other forms and documents typically accompany it, each serving its own unique purpose in ensuring the child's rights, health, and identity.
This list underscores the mix of joy and duty that accompanies the arrival of a new child. While the focus is naturally on the health and well-being of the newborn, it's important for parents to navigate these practical steps efficiently. By understanding and preparing these essential documents, parents can ensure a smoother path for their family's future, all starting with the vital record of birth.
The CDC U.S. Standard Certificate of Live Birth form shares similarities with the Death Certificate form in the United States. Both forms collect vital statistics that are essential for national health and population tracking purposes. While the Certificate of Live Birth documents the entry of a new individual into the population, the Death Certificate records the departure. They both contain demographic information about individuals, ensuring that the data necessary for public health, policy-making, and historical records is accurately captured. This makes them indispensable tools for government and health agencies in maintaining accurate and updated civic records.
Another document comparable to the CDC U.S. Standard Certificate of Live Birth form is the Marriage Certificate. Marriage Certificates, like Birth Certificates, are essential for legal identification and status change purposes. They both serve as vital records, establishing legal recognition of significant life events. These documents are used to confirm legal statuses, which can affect taxation, benefits, and inheritance. Furthermore, both certificates must be filed and verified by local government clerks, showcasing a procedural similarity in how significant life milestones are officially recorded and recognized legally.
The Passport Application form also reflects similarities to the CDC U.S. Standard Certificate of Live Birth form. A birth certificate is often required to obtain a passport, as it proves citizenship and provides the primary record of identity. Both forms are integral for establishing identity, albeit for different purposes: one for the recognition of existence within a country’s jurisdiction, and the other for international travel. Additionally, both involve thorough processes to verify the information provided, ensuring the integrity of the identification and preventing fraud.
Similarly, the Social Security Card application process is in line with the purposes of the Birth Certificate. From birth, individuals in the United States are typically registered for a Social Security Number (SSN), a process that requires a birth certificate to confirm identity and citizenship. These documents together secure an individual's access to a range of services and entitlements, such as healthcare, education, and employment benefits. They act as foundational identification tools, facilitating the individual's participation in civic and economic activities.
Finally, the Application for a Driver’s License shares common ground with the Certificate of Live Birth. Both are stepping stones in the journey of legal identification and gaining rights within society. To apply for a driver's license, one usually needs to present a birth certificate as proof of age and identity. This highlights how the birth certificate not only marks the beginning of a person's legal identity but also plays a recurring role in verifying that identity throughout the individual's life. Each document, in its own way, serves to legitimize and validate the individual's rights and responsibilities in society.
Completing the CDC U.S. Standard Certificate of Live Birth form accurately is crucial. It is the first legal acknowledgment of a child's existence and vital for obtaining future documents. Here are essential dos and don’ts to ensure the process is smooth and the information is error-free.
Things You Should Do
Things You Shouldn't Do
By following these guidelines, you can ensure the form is completed correctly, providing a solid foundation for your child's documentation. Remember, this certificate is a pivotal document in your child's life, serving as the basis for many future legal, educational, and health documents.
When it comes to the U.S. Standard Certificate of Live Birth form, managed and advised upon by the Centers for Disease Control and Prevention (CDC), several misconceptions commonly circulate. These misunderstandings can lead to confusion about the form's purpose, use, and the information it contains. Addressing these misconceptions is essential for a clearer understanding of the document's role in vital statistics and public health.
The CDC U.S. Standard Certificate of Live Birth form is an essential document that records a newborn's entry into the world. Its completion is not only a legal requirement but also vital for ensuring that the child receives proper recognition by the government. The information gathered through this form plays a crucial role in national health statistics and the planning of public health strategies. Here are seven key takeaways to remember when filling out and using this form:
Completing the CDC U.S. Standard Certificate of Live Birth form is a significant responsibility that provides the first official recognition of a child's existence. Taking care to accurately and promptly fill out the form ensures the child's rights and access to services are secured from the start.
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