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Fetal and Infant Mortality Review (FIMR) Conference Call Minutes by mm6889

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									Charlie Crist                                                       Ana M. Viamonte Ros, M.D., M.P.H.
Governor                                                                        State Surgeon General


                         Fetal and Infant Mortality Review (FIMR)
                                 Conference Call Minutes
                                    December 16, 2009


 Toll-free number: (888) 808-6959
 Conference Code: 0281037#

 Facilitator: Louise Jones
 Recorder: Leesa Bebley


 Attendance:

                          FIMR Sites and Support                               Present
  Northeast Florida Healthy Start Coalition, Inc.
  Bay, Franklin, Gulf Healthy Start Coalition, Inc.                                X
  Broward Healthy Start Coalition, Inc.                                            X
  Chipola Healthy Start                                                            X
  Healthy Start Coalition of Miami-Dade, Inc.                                      X
  Escambia County Healthy Start Coalition, Inc.                                    X
  Healthy Start Coalition of Flagler and Volusia Counties, Inc.                    X
  Healthy Start Coalition of Hardee/Highlands/Polk Counties, Inc.                  X
  Capital Area Healthy Start Coalition, Inc.                                       X
  Healthy Start Coalition of Pinellas County, Inc.                                 X
  Healthy Start Coalition of Sarasota County, Inc.
  Jason Stamm, BASINET Technical Assistance
  Dani Noell, FIMR Technical Assistance                                            X
  Cheryl Carpenter, HSC of Osceola                                                 X


 Department of Health Attendees: Julie Beaman, Melba M. Hawkins-Littles, Nicole Hill, Louise
 Jones, Chris LeClair, Marie Melton, Adam Reeves and Leesa Bebley of the Infant, Maternal and
 Reproductive Health Unit. Ken Jones, Gary Sammet and Sharon Dover representing Vital
 Statistics.


 Welcome- Louise Jones, Facilitator:
 Louise Jones welcomed all to the quarterly Fetal and Infant Mortality Review (FIMR) conference
 call. Louise introduced Melba Hawkins-Littles and Nicole Hill, two new members of the IMRH
 team to the group.
FIMR Minutes
Page Two
December 16, 2009



Topics:

1. Guidelines regarding fetal viability – Lisa Lamar, Chipola Healthy Start

Lisa has had a few cases where the infant was estimated 21-22 weeks gestation, less than 500
grams and another instance where the physician documented a spontaneous abortion;
however, a birth certificate was done and was counted as a fetal demise.

Ken Jones, Gary Sammet, and Sharon Dover representing Vital Statistics were on the call to
address this issue. In the state of Florida, a birth certificate is prepared if the physician
observes any sign of life, such as beating of the heart, pulsation of the umbilical cord, and
definite movement of the voluntary muscles. The physician is the one that makes that
determination.

Vital Statistics has provided us with copies of the CDR Operations Manual (COM) and the Vital
Records Registration Handbook. The COM, used in the day-to-day operations of the county
vital statistics offices, can be found on the intranet website. The handbook, used by the
preparers of the vital records (hospitals, midwives, funeral directors, physicians, and medical
examiners), can be found of the Internet website.

In addition, there was a discussion regarding Catherine’s Law that was passed in 2006 that
allowed a Certificate of Birth resulting in Stillbirth to be prepared by request of the parents. This
certificate is filed along with the Fetal Death Certificate.


2. Abstracting a fetal death due to maternal demise – Lisa Lamar, Chipola Healthy Start

Lisa requested information regarding what other programs have done regarding possibly
abstracting a fetal death due to maternal demise.

Dani Noell shared how the PAMR process is done at the state level and reviews approximately
15 cases per quarter. There should not be a problem with the abstractor reviewing the fetal
record; however, as with all FIMR cases, confidentiality is essential.


3. Updating the Healthy Start Screen section of BASINET – Audra Fyock, Healthy Start
Coalition of Hardee/Highlands/Polk
FIMR Minutes
Page Three
December 16, 2009



The Healthy Start screen section of BASINET has not yet been updated to reflect the new
Healthy Start risk screen. When will it be updated in BASINET?

Although Jason Stamm was not able to be on the call, he did provide a response via e-mail.

“We have already built data tables for the new Healthy Start screening form in another one of
our systems. This will make it easy for us to revise the page in BASINET. Since this new form
has been in effect since March 2008, we are assuming that losses now being entered into
BASINET would NOT have been screened using the OLD form. We will be posting the change
to Florida BASINET by January 1, 2010 and sending a notice to all Florida BASINET users.
There are several other updates to BASINET that we will be posting early next year, and Florida
users will be alerted accordingly with training provided as necessary.”


4. FIMR Process - Dani Noell

Dani shared that she had contacted the FIMR projects and everyone seemed to be doing well.
She continues to praise the projects for the important work they do.

Dani also shared that June 2010 marks the 20th year of the collaboration between the Health
Resources and Services Administration (HRSA), Maternal and Child Bureau (MCHB), and the
American College of Obstetricians and Gynecologists (the College) in the National and Infant
Mortality Review (NFIMR) Program Resource Center. Leading up to this twenty year milestone,
NFIMR will publish several new documents. The first is a new FIMR brochure, Making a
Difference in the Community, that is available on the NFIMR website. In addition, the National
Center for Cultural Competence in collaboration with NFIMR will publish The FIMR Tool to
Assess Cultural Competence, which is designed specifically for local program self evaluation.
They also plan to hold a national conference celebrating NFIMR’s twenty years of collaboration
and community action in late 2010 or early 2011.


5. Closing remarks – Louise Jones

Happy Holidays and many thanks for all you do to improve the lives of moms and babies in
Florida.


Next Call - Louise Jones

Please mark your calendars, our next call on Wednesday, March 24, 2010 at 9:30 am eastern
time.
Charlie Crist                                                                    Ana M. Viamonte Ros, M.D., MPH
Governor                                                                                     State Surgeon
General


                                               STATE OF FLORIDA




      BUREAU OF VITAL STATISTICS


                VITAL RECORDS
            REGISTRATION HANDBOOK
              November 2008 Revision


                                                     BUREAU OF VITAL STATISTICS
                                                             1217 Pearl Street
                                                              P.O. Box 210
                                                        Jacksonville, Florida 32231




Vital Records Registration Handbook, 2008 Revision
Vital Records Registration Handbook, 2008 Revision
INTRODUCTION
     Vital Statistics Staff
                                          TALLAHASSEE STAFF

                            C. Meade Grigg – State Registrar
                            Office of Health Statistics & Assessment

                                          JACKSONVILLE STAFF

                            Ken Jones – Deputy State Registrar
                            Gina Aldridge – Computer Specialist
                            Eric Mays – Computer Specialist
                            Ray Herz – Vital Records Administrator

                            Kevin Wright – Certification
                            Evelyn Fugate – Client Services
                            Kathy Stephens – Distribution
                               Darlene Newmans – Search

                            Betty Shannon – Amendments
                            Gwen McNeil – Corrections, Paternity/Child Support
                            Enforcement
                               Lorraine Kratz – Adoptions, Delays
                               VACANT – Corrections, Legal Name Changes
                               Ana Goold-- Paternity/Child Support Enforcement

                            Jim Ballard – Current Registration/Quality Assurance
                            Paula Mundy – Birth
                            Kenny Higginbotham – Death/Fetal Death/Marriage/Divorce
                            Sharon B. Dover – Quality Assurance
                               Jana Duffy – Quality Assurance
                               Mike Grant – Quality Assurance
                               Chris Mays – Quality Assurance
                               Cindy Russ – Quality Assurance

                            Gary Sammet – Public Health Statistics
                            Felipe Lorenzo-Luaces – Data Management, Multiple Cause of
                            Death Classification
                            Velida Osmanovic – Data Management

                            Bill Hughes – Administrative Services
                            Vicki Cook – Fiscal
                            Michelle Campbell – General Services/Purchasing



Chief Deputy Registrar Operations Manual, 2008 Revision
INTRODUCTION
          Chief Deputy Registrar Advisory
               Committee (CDRAC)
                            Luz Perez, Hillsborough County – Committee Chair
                            Willie Dean Mayo, Columbia County, North/Northwest Florida
                            Janie Carpenter, Escambia County, North/Northwest Florida
                            Alexa Doepel, Brevard County, Central Florida
                            Pat Kennedy, Flagler County, Central Florida
                            Gloria Norfleet-Robinson, Orange County, Central Florida
                            Chris Mashintonio, Charlotte County, Southwest Florida
                            Eva Williams, Broward County, Southeast Florida




Chief Deputy Registrar Operations Manual, 2008 Revision
FORWARD
                                      This handbook is designed to assist registrars, physicians,
                                      funeral directors, midwives, hospital personnel, and others
                                      engaged in the operation of the vital statistics program.
                                      The procedures recommended are based on Florida
                                      Statutes and Florida Administrative Code.

                                      For those facilities online with the Electronic Birth
                                      Registration (EBR) system, there is a separate manual
                                      with detailed instructions on processes, the EBR Birth
                                      Manual, which can be obtained from the chief deputy
                                      registrar at the county health department.

                                      The first statewide vital statistics law in Florida was
                                      enacted by the 1899 legislature that established a system
                                      for physicians to report births and deaths. For many
                                      reasons, this law was ineffective. In 1915, the legislature
                                      passed a law based on the national Model Vital Statistics
                                      Act that became effective January 1, 1917. This was the
                                      first comprehensive registration system for Florida births,
                                      deaths, and fetal deaths. In 1927, a law was enacted that
                                      established a central repository for marriage licenses and
                                      reports of dissolutions of marriage (divorce and
                                      annulments).

                                      Subsequent legislation has provided for the filing of
                                      delayed birth and death certificates, the correction of birth
                                      and death certificates, as well as amendments resulting
                                      from court ordered name changes, adoptions and paternity
                                      acknowledgments.

                                      The essential elements of an effective system for
                                      registration of vital records and compilation of health
                                      statistics are completeness, timeliness, and accuracy,
                                      which require the full cooperation of all persons involved in
                                      vital statistics registration.

                                      The Bureau of Vital Statistics welcomes and solicits any
                                      comments or recommendations regarding this handbook
                                      that will increase its value to the users.

                                                                    C. Meade Grigg
                                                                    State Registrar
                                                                    Bureau of Vital Statistics
                                                                    November 2008




Vital Records Registration Handbook, 2008 Revision
Vital Records Registration Handbook, 2008 Revision
                                           TABLE OF CONTENTS
INTRODUCTION

FORWARD

         CHAPTER 1 - GENERAL ........................................................................................... 7
          CENTRAL REGISTRATION SYSTEM.............................................................. 7
          REGISTRATION OF VITAL RECORDS........................................................... 8
          IMPORTANCE OF VITAL RECORDS .............................................................. 8
          ENFORCEMENT OF VITAL STATISTICS LAWS.......................................... 9
          PENALTIES FOR VIOLATION OF VITAL STATISTICS LAWS................. 9
          FUNCTIONS OF LOCAL VITAL STATISTICS OFFICES............................. 9
          STANDARDS OF ACCEPTABILITY FOR VITAL RECORDS.................... 10
          COMPLETE INFORMATION REQUIRED .................................................... 11
          STANDARD FORMS TO BE USED .................................................................. 11
          CONFIDENTIAL NATURE OF VITAL RECORDS....................................... 11
          CERTIFIED COPIES OF VITAL RECORDS.................................................. 12
          APOSTILLE OR EXEMPLIFIED COPIES OF VITAL RECORDS............. 14
          MICROFILM........................................................................................................ 14
          CONSULTANT ASSISTANCE........................................................................... 15
          RETENTION OF VITAL RECORDS................................................................ 15
          CUSTODIAN OF RECORDS ............................................................................. 15
          DISASTER PREPAREDNESS PLAN ................................................................ 15
         CHAPTER 2 - REGISTRATION OF LIVE BIRTHS................................................ 19
          DEFINITION ........................................................................................................ 19
          NEED FOR REGISTRATION ............................................................................ 19
          STATISTICAL DATA ......................................................................................... 19
          BIRTH INFORMATION CONFIDENTIAL..................................................... 19
          RECORD TO BE FILED (S. 382.013, F.S.) ....................................................... 19
          WHEN MUST A BIRTH RECORD BE FILED................................................ 20
          WHO FILES.......................................................................................................... 20
          BIRTH RECORD - FORM (S. 382.003 (7), F.S.)............................................... 20
          BIRTH RECORD - SIGNATURES .................................................................... 20
          ELECTRONIC BIRTH REGISTRATION........................................................ 20
          ENUMERATION AT BIRTH ............................................................................. 21
          HOME BIRTHS.................................................................................................... 21
          PLURAL BIRTHS ................................................................................................ 22
          FOUNDLINGS...................................................................................................... 22
          SURRENDERED/ABANDONED BABIES........................................................ 23
          EVIDENTIAL WEIGHT OF RECORDS .......................................................... 24
          HOSPITAL'S RESPONSIBILITY IN BIRTH REGISTRATION .................. 24
          HUSBAND TO BE SHOWN................................................................................ 24
          SURROGATE MOTHERS OR GESTATIONAL SURROGACY (S. 382.013,
          742.16, F.S.)............................................................................................................ 25


Vital Records Registration Handbook, 2008 Revision
          BABIES TRANSFERRED ................................................................................... 25
          HEALTHY START .............................................................................................. 25
          BIRTH AMENDMENTS/CORRECTIONS ...................................................... 26
          PATERNITY ACKNOWLEDGMENT, IN-HOSPITAL ................................. 26
          PROSPECTIVE ADOPTIONS - NEW BIRTHS .............................................. 28
          LATE REGISTRATION OF BIRTHS............................................................... 28
          DELAYED BIRTH RECORDS........................................................................... 28
          BIRTH OCCURRING IN ANOTHER REGISTRATION
          DISTRICT/COUNTY........................................................................................... 28
          NON-FLORIDA BIRTH ...................................................................................... 29
          BIRTHS THAT OCCURRED IN OTHER STATES, OUTLYING U.S.
          AREAS, AND OVERSEAS BIRTHS INVOLVING U.S. NATIONALS ........ 29
         CHAPTER 3 - PREPARING THE CERTIFICATE OF LIVE BIRTH ..................... 31
          HEALTHY START ITEMS ................................................................................ 31
          DEMOGRAPHIC PORTION OF THE LIVE BIRTH CERTIFICATE ........ 31
          PATERNITY ACKNOWLEDGMENT.............................................................. 40
          FOR ADMINISTRATIVE USE ONLY.............................................................. 42
          INFORMATION FOR MEDICAL AND HEALTH USE ONLY .................... 44
         CHAPTER 4 – REGISTRATION OF DEATHS ....................................................... 57
          GENERAL............................................................................................................. 57
          CERTIFICATE TO BE FILED .......................................................................... 57
          DEATH RECORD - FORM ................................................................................ 57
          RESPONSIBILITIES OF LOCAL REGISTRARS IN DEATH
          REGISTRATION ................................................................................................. 57
          FUNERAL DIRECTOR/DIRECT DISPOSER'S RESPONSIBILITY........... 58
          BURIAL WITHOUT FUNERAL DIRECTOR ................................................. 58
          APPOINTMENT OF SUBREGISTRARS ......................................................... 59
          RESPONSIBILITIES OF SUBREGISTRARS.................................................. 59
          BURIAL-TRANSIT PERMIT REQUIRED (S. 382.006 F.S.).......................... 60
          BURIAL WITHOUT PERMIT ........................................................................... 60
          DISINTERMENT/REINTERMENT PERMIT ................................................. 61
          PHYSICIAN'S RESPONSIBILITY IN DEATH REGISTRATION ............... 61
          WHO MAY SIGN MEDICAL CERTIFICATION ........................................... 62
          PROBLEM GETTING PHYSICIAN TO SIGN RECORD ............................. 62
          RESPONSIBILITY IN DEATHS WITHOUT MEDICAL ATTENDANCE . 63
          RESPONSIBILITY OF CEMETERY SEXTON............................................... 64
          TEMPORARY (PENDING) DEATH RECORDS (s. 382.008 (4, 5) F.S.) ....... 64
          UNIDENTIFIED BODIES ................................................................................... 65
          ACCESS TO DEATH CERTIFICATES............................................................ 66
          FUNERAL DIRECTOR APPLICATION FOR DEATH CERTIFICATIONS
          ................................................................................................................................. 66
          CORRECTION OF DEATH CERTIFICATES ................................................ 67
          DELAYED DEATH CERTIFICATES............................................................... 67
          PRESUMPTIVE DEATHS .................................................................................. 68
          CREMATION ....................................................................................................... 69



Vital Records Registration Handbook, 2008 Revision
           BURIAL OF HUMAN REMAINS AT SEA (EPA REGION 4)....................... 69
           TRANSPORTATION OF BODIES .................................................................... 69
           DEAD BODY TRANSPORTED FROM OUTSIDE THE STATE.................. 69
           UNCLAIMED BODIES ....................................................................................... 70
           BODIES DONATED TO MEDICAL SCIENCE............................................... 70
           DEATH THAT OCCURS IN ANOTHER COUNTY (REGISTRATION
           DISTRICT)............................................................................................................ 70
           DEATH THAT OCCURS OUTSIDE OF FLORIDA ....................................... 70
         CHAPTER 5 – PREPARING THE DEATH CERTIFICATE ................................... 71
           DETAILED INSTRUCTIONS FOR PREPARING THE DEATH
           CERTIFICATE..................................................................................................... 71
           DEMOGRAPHIC SECTION OF RECORD TO BE COMPLETED BY
           FUNERAL DIRECTOR....................................................................................... 71
           MEDICAL SECTION OF RECORD ................................................................. 87
           REVIEWING MEDICAL CERTIFICATION ON DEATH CERTIFICATES
           ................................................................................................................................. 89
         CHAPTER 6 – THE BURIAL TRANSIT PERMIT .................................................. 95
           GENERAL............................................................................................................. 95
           DETAILED INSTRUCTIONS FOR COMPLETING THE BURIAL-
           TRANSIT PERMIT.............................................................................................. 96
         CHAPTER 7 - REGISTRATION OF FETAL DEATHS......................................... 103
           DEFINITION ...................................................................................................... 103
           FETAL DEATH REGISTRATION (S. 382.008(1), F. S.)............................... 103
           SIGNATURES REQUIRED .............................................................................. 103
           RESPONSIBILITY IN FETAL DEATH REGISTRATION.......................... 104
           DISPOSITION OF THE FETUS ...................................................................... 104
           CONFIDENTIALITY ........................................................................................ 105
         CHAPTER 8 – PREPARING THE CERTIFICATE OF FETAL DEATH.............. 107
           DEMOGRAPHIC PORTION OF THE FETAL DEATH CERTIFICATE . 107
           CAUSE/CONDITIONS CONTRIBUTING TO FETAL DEATH ................. 118
           INFORMATION FOR MEDICAL AND HEALTH USE ONLY .................. 119
         DEFINITION OF TERMS ....................................................................................... 129
         FOREIGN OR HIGH-SEAS BIRTHS & DEATHS & CERTIFICATES OF
         CITIZENSHIP .......................................................................................................... 115
         WEB SITES .............................................................................................................. 117




Vital Records Registration Handbook, 2008 Revision
Vital Records Registration Handbook, 2008 Revision
                                                CHAPTER 1 – GENERAL




                                       CHAPTER 1 - GENERAL

Vital statistics is usually an assigned responsibility of state health agencies and provides the
foundation upon which many other parts of a public health program are constructed. The
constituent parts of a comprehensive vital statistics program present the life history of a
county, state, or nation.

Public health statistics have come to be regarded as an indispensable tool for the proper
planning, management, and evaluation of many health programs. The compilation of vital
statistics is of ancient origin. Enumerations of people were carried out long before the birth
of Christ, notably in China, Egypt, Persia, Greece, and Rome, primarily for purposes of
taxation and to determine available military manpower. Data related to births, deaths, and
marriages were recorded in elementary form in the old church registers in England. The
oldest known copy of these so-called "bills of mortality" can be seen in the British Museum
and is dated November 1532.

The value of birth and death statistics is somewhat reduced when some of these events go
unrecorded. The Bureau of Census has indicated that although nearly all births in the
country are registered, there are still thousands of babies born each year who are not
registered.

Because of burial requirements, deaths are reported to a greater degree of completeness
than are births. However, the value of death records is impaired because of inaccurate or
incomplete reporting. For example, it has happened that the cause of death was misstated
in order to circumvent potential social stigma.

Efforts to secure better reporting of births, deaths, and fetal deaths require constant
vigilance on the part of staff in hospitals, funeral homes, medical examiner offices and
others concerned with vital statistics programs.

CENTRAL REGISTRATION SYSTEM

In Florida, the Bureau of Vital Statistics operates the central registration system by which the
department is able to answer inquiries concerning any birth, death, or fetal death certificate
filed in the state. Original birth and death certificates, when received from local registrars,
are reviewed for possible errors and omissions, and if needed, a query is instituted. All
records are microfilmed for archival storage and permanently filed in a safekeeping vault.
Information from both the birth and death record is entered into the vital statistics database.

An important function of the state office is to issue certifications of records to eligible
individuals in need of such records.




Vital Records Registration Handbook, 2008 Revision                                               7
                                                CHAPTER 1 – GENERAL



REGISTRATION OF VITAL RECORDS

The registration of births, deaths, and fetal deaths is a state and local function. The vital
statistics laws of Florida provide for a continuous and permanent birth and death registration
system. This system depends upon the conscientious efforts of local registrars, physicians,
hospital personnel, midwives, funeral directors, medical examiners, and others involved in
preparing or certifying information needed to complete the original records.

Florida is divided into 67 local registration districts (counties) that facilitate collection of vital
records. These districts are coextensive with the jurisdictional area of the county health
department, and the local county health department director or administrator traditionally
serves as local registrar of the county or counties under his/her jurisdiction. The local
registrar is required to see that a complete record is registered promptly with the local vital
statistics office for each vital event occurring in the county. When a death or fetal death
record is accepted for registration, it is the duty of the local registrar to have issued a burial-
transit permit that authorizes disposition of the remains, unless a subregistrar commissioned
within the funeral establishment has issued a permit. The local registrar sends all original
vital records to the state office and usually keeps a copy of each vital record registered in
the county.

Because of the many legal, public health, research, and social welfare uses of vital records,
each record should be prepared as completely and accurately as possible. Florida Statutes
and Florida Administrative Code specify who may obtain certifications of individual records.
The records themselves are designed to separate the data that will be used only for
medical, statistical, and research purposes from other information.

IMPORTANCE OF VITAL RECORDS

The preservation of vital records increases in importance each year. Prior to World War II,
birth records were needed infrequently. Today a birth record is virtually a necessity. It is
needed for admission to school, to obtain a driver's license, a work permit, the right to vote,
eligibility for retirement, social security benefits, to prove citizenship, to obtain public
assistance for dependent children, and many other uses. Due to recent international
events, a person’s identity and subsequent birth record has become even more valuable.
Florida Vital Statistics in conjunction with federal legislation, such as the Real ID Act and
proposed Intelligence Reform Act, is charged with the responsibility of safeguarding this
information and keeping it from unauthorized persons.

The death record also serves many important purposes. In order for families to transact
business after the death of a loved one, a death record is required. It is used as a basis for
statistical compilation of death trends and causes, public health planning, proof for life
insurance claims, survivors' social security and veterans' benefits, public assistance claims
for widows and dependent children, obtaining burial-transit permits, and other purposes.

Fetal death records provide useful data as to causes of fetal death and they may also be of
legal value to the family.

Marriage and dissolution of marriage records that are transmitted to the state office by the
clerks of court prove rights to insurance, pension, military allowances, establish legitimacy
status, citizenship, indicate legal change of name, and have information of interest to public
health, social welfare, demography, and sociology professionals.


Vital Records Registration Handbook, 2008 Revision                                                   8
                                                CHAPTER 1 – GENERAL




ENFORCEMENT OF VITAL STATISTICS LAWS

The state registrar is charged with the uniform and thorough enforcement of the vital
statistics laws throughout the state and must have cooperation and assistance from local
registrars, chief deputy registrars, deputy registrars, and subregistrars to ensure
compliance.

The state registrar, either personally or by an accredited representative, has the authority to
investigate cases of irregularity or violation of laws. Local registrars should report cases of
suspected violations of vital statistics laws to the state registrar, who may make further
report to the state attorney, county attorney, or other authority having charge of the
prosecution of misdemeanors and felonies in the county where the violation occurred. Upon
request, the attorney general will assist in the enforcement of the provision of the vital
statistics laws.

PENALTIES FOR VIOLATION OF VITAL STATISTICS LAWS

Failure to file records on time is a direct violation of vital statistics law. Section 382.025 (9),
Florida Statutes, states, “…the department may impose a fine which may not exceed $1000
for each violation of this chapter or rules adopted there under. Each day that a violation
continues may constitute a separate violation...”

Birth records must be filed within five calendar days after birth as stated in s. 382.013, F.S.

Death and fetal death records must be filed within five calendar days after death, or, if an
extension of time is granted, an additional five business days are allowed as stated in
s. 382.008 (1), F.S. If the death requires a further extension of time, the funeral director
must provide written justification to the registrar. The funeral director should file a Death
Registration Delay Report (VS 1355), detailing the efforts to obtain a completed record.

Persons who willfully make or alter any certificate or record, except in accordance with the
provisions of the vital statistics laws, or who willfully furnish false or fraudulent information
affecting any record required by this law, are guilty of a third degree felony and are subject
to a fine of not more than $1000 or imprisonment not to exceed 60 days, or both.

Those who knowingly transport or accept for transport, inter or otherwise dispose of a dead
body without an accompanying burial-transit permit issued in accordance with the provisions
of the vital statistics laws, are subject to a fine of not more than $1000 or imprisonment not
to exceed 60 days, or both.

Except where a different penalty is provided, any person who violates any of the provisions
of the vital statistics laws, rules, or regulations, or who neglects or refuses to perform any of
the duties imposed upon him by law, shall be subject to a fine of not more than $1000, or
imprisonment not to exceed 60 days, or both. In addition to any other sanction or penalty
allowed by law, the department may impose a fine not to exceed $1000 for each violation of
sections 382.006, 382.007, 382.008, or 382.013 Florida Statute (F.S.) or Florida
Administrative Code 64V-1.

FUNCTIONS OF LOCAL VITAL STATISTICS OFFICES



Vital Records Registration Handbook, 2008 Revision                                                    9
                                                CHAPTER 1 – GENERAL



Upon acceptance of appointment, each local registrar must designate a chief deputy
registrar (CDR) and may designate other deputy registrars (s. 382.005 (4) F.S.). The
person appointed as chief deputy registrar will act in the absence or disability of the local
registrar. Each chief deputy and deputy registrar are subject to the same laws, regulations,
and instructions governing the actions of the local registrar.

Traditionally, the CDR assumes the responsibility of managing the day to day operations of
the vital statistics unit. There are times and circumstances when the CDR will look to the
local registrar to assist in specific situations.

A summary of the minimum functions of the county vital statistics office would include:

    1. Assist in the enforcement of the state law relating to the registration of vital records
        in the county;
    2. Review of records for completeness and accuracy before acceptance;
    3. Review of cause of death entries on death and fetal death records for possible
        medical examiner jurisdiction;
    4. Daily transmittal of the original records to the state registrar;
    5. Track timeliness in filing of vital records;
    6. Follow-up on late filing of records;
    7. Provide training and assistance to hospital personnel, midwives, funeral directors,
        physicians and medical examiners in connection with the preparation and filing of
        vital records;
    8. Issuance of Burial-Transit Permits for disposal of bodies for those deaths that occur
        in their county;
    9. Preparation and preservation of local file copies and indices as appropriate;
    10. Preparation of certified copies of vital records in response to public requests
        (optional);
    11. Attend scheduled state office training sessions and conference calls.

When reviewing records for acceptability and errors or omissions are found, the record
should be returned to the preparer for completion, correction or to be re-prepared. Under
no circumstance is the registrar to make any change or alteration to the record. The local
vital statistics office has no authority to add or correct information on vital records.

STANDARDS OF ACCEPTABILITY FOR VITAL RECORDS

Acceptable vital records should normally not show alterations, strikeovers, traceovers, or
erasures. If an error has been made in preparation by the hospital, physician, funeral
director, or midwife, a new record should be prepared. Abbreviations should be avoided if
space permits making the entry in full. Each item should be completed, unless there are
specific instructions to the contrary. Each record must be an original. Facsimile signatures
are not acceptable for authenticating vital records by physicians, funeral directors, midwives,
medical examiners, or other officials responsible for filing. Registrars should normally not
accept records containing any of the following defects:

    1.   Whiteout, erasures, alterations, or obvious additions;
    2.   Omission of items unless such omission is satisfactorily accounted for;
    3.   Rubber stamp or typewritten signatures; an original signature is required;
    4.   Traceovers;
    5.   A record marked "copy" or "duplicate;"


Vital Records Registration Handbook, 2008 Revision                                            10
                                                CHAPTER 1 – GENERAL



    6. Obviously improper or erroneous information;
    7. A form other than that currently required;
    8. A record not typewritten;
    9. All items must be legible;
    10. Information relative to the father of a child born to an unmarried mother, unless both
        the mother and father sign the completed paternity acknowledgment on the front of
        the birth record. This does not preclude acceptance of such information when a
        court of competent jurisdiction has determined paternity.

COMPLETE INFORMATION REQUIRED

The necessary data for vital records are obtained from several sources. These include
medical records, the mother, father, spouse, relatives, or persons who have knowledge of
the facts, physicians, or hospital records. Florida statutes require physicians, midwives,
funeral directors, informants, and all other persons having knowledge of the facts to supply
such information as they may possess regarding any birth, death, or fetal death occurring
within the state.

STANDARD FORMS TO BE USED

The state registrar is responsible for the preparation, printing, and distribution of forms to
local registrars to be used in registering, recording, and preserving the records required by
the vital statistics laws. Detailed instructions as required to procure the uniform observance
of compliance with these laws are to be furnished. Only the prescribed forms or those
approved by the state registrar may be used in the preparation of vital records.

It is suggested that the standard application be used when ordering certified copies from
either the state office or the county office. The state office applications are available from
the county vital statistics offices or from the department’s website at:
http://www.doh.state.fl.us/planning_eval/phstats/index.html
The county vital statistics offices have standard applications, with the specifics unique to
that county. Contact the Chief Deputy Registrar for the appropriate applications.

There are several state approved software packages for printing both birth and death
records. For specifics on the approved packages, contact the state office.

CONFIDENTIAL NATURE OF VITAL RECORDS

The basic reason for confidentiality of vital records is a person's right to privacy. Vital
records involve the most intimate affairs of the individual that, if unwarrantedly disclosed,
might be used for criminal or unworthy motives. Hospitals and physicians, who, as
mandated, provide information for vital records, do so with the understanding that such
information will not be abused. The confidentiality of a persons’ medical information is
supported by the Health Information Portability and Accountability Act (HIPAA). Public
health reporting and surveillance for birth and death records are exempt from these
restrictions.

Except for birth records over 100 years old that are not under seal pursuant to court order,
birth record information, under ch. 382, F.S., is restricted and confidential. Certifications of
birth records are available only to those persons specified by statute. The registrar may not



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                                                CHAPTER 1 – GENERAL



permit access to, or inspection of, birth records unless satisfied that the applicant meets
statutory requirements.

Anyone may receive a certified copy of the death record without cause of death, upon
completion of an application and payment of the required fee. While death records do not
bear the exact restricted confidentiality of birth records, the cause-of-death section is
confidential and available only to those persons specified by statute, except for death
records over 50 years old. Cause of death information is to be withheld from the morbidly
curious. Death records contain the physician's statement as to the cause and
circumstances of the death and are a legal extension of the doctor-patient relationship.
Therefore, the cause of death section of the death record is confidential.

While protecting the integrity of vital records, it should be noted that access to confidential
vital records can be granted by the department for the purposes of health program planning,
evaluation, and research purposes.

CERTIFIED COPIES OF VITAL RECORDS

The state office made mandatory the use of safety paper for all certifications issued after
September 1, 1987. Funeral directors, notaries public, and all other persons not specifically
authorized by state law or rule are prohibited from preparing or issuing any document that
purports to be an original or certified copy of an original certificate of birth, death, or fetal
death. Such an act is punishable pursuant to s. 382.026 F.S.

Birth/wallet cards became obsolete May 31, 2002

Local and chief deputy registrars are authorized to issue certifications of Florida vital records
through the e-Vitals system, pursuant to s. 382.025, F.S. All requests for certified copies
should be made on the appropriate standard application, copies of which are available from
the state office, the department website:
http://www.doh.state.fl.us/planning_eval/vital_statistics/index.html, or the county vital
statistics office.

The county application is basically the same as the state application, but provides county
specific information regarding fees, address, phone number, etc.; the state’s application has
fees and address information for the state office. There is a separate generic funeral
director application that can be used at any county office, but the funeral director must verify
the fees, address, etc. with the individual county. To avoid misunderstanding, the applicant
should complete the form. Questions on applications should be directed to the CDR in the
county office.

Request from unauthorized person -- When an applicant, other than an authorized person
as outlined in statute, requests a certification of a confidential vital record, the Affidavit to
Release a Birth Certificate (DH 1958) or Affidavit to Release Cause of Death (DH 1959)
should be completed by someone who is authorized to receive that certification. This
notarized affidavit, along with the applicant’s photo identification (ID), must accompany the
completed application. The affidavit presented for the purpose of obtaining a certification of
a vital record is valid for that issuance only and must be the original document; faxed copies
are not normally acceptable. Whiteout, strikethroughs, or alteration of any kind is
unacceptable. An updated affidavit must be presented for each subsequent issuance. A
notarized statement from an authorized person can be utilized if the applicant does not have


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                                                CHAPTER 1 – GENERAL



access to the aforementioned affidavit. The statement must contain all information required
in the affidavit in order to be acceptable and must be the original document; faxed copies
are not normally acceptable.

A durable power of attorney must be notarized; has no expiration date, unless so stated;
and ceases upon death of the person (the “grantor”) initiating the document.

A court order is a mandate, direction or command authoritatively given by the court and
signed by a judge. A court order may be presented as proof of authorization for an
individual to receive a certification that is not otherwise available to them. Unless so stated
in the court order, there is no expiration of the order.

Birth records and death records with cause of death are confidential and exempt from
s. 119.07 F.S.

Certified copies of birth records can be issued only to the registrant, if of legal age; parent or
guardian, or legal representative of one of these just named; or upon a court order. A valid
photo ID is required for all requests.

Certified copies may be obtained for births that occurred in this state, some as far back as
1865. 100 years after the date of birth, the birth record becomes public information and can
be issued to any applicant.

In the case of a deceased registrant, upon receipt of a certified copy of the death record,
certification of the birth record may be issued to the registrant’s spouse; child, grandchild,
sibling, if of legal age; or to a legal representative of any of these persons as well as the
registrant’s parent.

Certified copies of death records showing the cause of death may be obtained by the
registrant's spouse or parent; child, grandchild or sibling, if of legal age; to any person
providing a will, insurance policy or other document demonstrating their interest in the estate
of the decedent; to any person who provides documentation that they are acting on behalf of
any of them; or under court order. A valid photo ID is required.

Anyone may obtain a copy without the cause of death section; no ID is required. Certified
copies may be obtained for deaths that occurred in this state, some as far back as 1877.
After 50 years from the date of death, cause of death information is no longer exempt from
s. 119.07 F.S. Anyone may obtain a copy showing cause of death on those records.

A certified copy of the original certificate of marriage may be obtained for marriages taking
place in our state subsequent to June 6, 1927. Information on marriages occurring before
that date must be obtained from the court issuing the marriage license.

A certified copy of the report of a divorce granted anywhere in the state may be obtained, if
the divorce took place subsequent to June 6, 1927. The names of both husband and wife
must be provided to permit us to locate the report of divorce sought. Copies of the final
decree of divorce must be obtained from the court granting the decree. Information on
divorces occurring before June 27, 1927 must also be obtained from the court that granted
the decree.




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                                                CHAPTER 1 – GENERAL



Statutory fees are required in advance for all certifications issued, as authorized in
s. 382.0255, F.S.

A Certificate of Birth Resulting in Stillbirth is created and issued upon the parent’s request.
Section 382.0085, Florida Statutes, allows for the creation and issuance of this special
certification for a fetal death. The issuance comes from the state office only and there must
already be a fetal death certificate on file.

Subsequent to the initial request, the Certificate of Birth Resulting in Stillbirth becomes
available as a public record. The certification is not considered proof of a live birth and
copies are available from 1947 to the present. An informational brochure, How to Apply for
a Florida Certificate of Birth Resulting in Stillbirth, is available to the funeral director when
meeting with families. Contact the CDR for a supply.

There is a specific application for this certificate, the Application for Florida Certificate of
Birth Resulting in Stillbirth, which is available on the website at:
http://www.doh.state.fl.us/planning_eval/phstats/index.html

Client requests for this service must be directed to the state office, Client Services Unit.

To obtain and use a Florida vital record under false or fraudulent purposes is a third-
degree felony, punishable by the terms and conditions set forth in Florida Statutes.

APOSTILLE OR EXEMPLIFIED COPIES OF VITAL RECORDS

An apostille or exemplified copy of a vital record includes a statement signed by the Florida
Secretary of State attesting that the state registrar is the custodian of the vital records of this
state as shown in the official records of the Florida Department of State. Inquiries for such
copies should be referred to the state vital statistics office.

The signature of the state registrar is registered with the Florida Department of State. The
certification must be one that is issued from the state office and contains the statement
for the secretary of state to sign. Accordingly, one that is issued from a county vital statistics
office is invalid for the purposes of obtaining an apostille or exemplified copy.

The fee for an apostille or exemplified copy certified by the secretary of state is $10.00
(check must be made payable to the "Secretary of State"). This fee is in addition to the
$29.00 fee for birth records and $25.00 fee for all other records (check made payable to the
Bureau of Vital Statistics) required by the state office for search, certification, processing,
and forwarding of the certified copy to the secretary of state.

There is a brochure explaining the apostille. Contact the chief deputy registrar to order a
supply of the brochure. For further information on the apostille process, contact the Client
Services Unit at the state office.

MICROFILM

The state registrar is authorized to reproduce or photograph the original of any or all vital
records received. Records so reproduced have the same force and effect as the original
and are to be treated as the original for the purpose of admissibility in evidence. A
certification of a vital record is equally admissible.


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                                                CHAPTER 1 – GENERAL




CONSULTANT ASSISTANCE

The state registrar is at all times willing to help with local vital records registration problems.
A cooperative relationship between state and local vital statistics offices is essential to the
operation of a successful statewide vital records registration program. The Quality
Assurance Unit was developed to assist with local registration problems as well as to
provide education and training for vital statistics staff, funeral home personnel, hospital staff
and other professionals involved in vital record registration.

RETENTION OF VITAL RECORDS

Florida statutes impose various retention schedules on different types of records. If there is
a question as to the retention of certain vital statistics documents, contact the state office.

CUSTODIAN OF RECORDS

The state registrar is the official custodian of vital records of the state and is required to
maintain such records in the manner prescribed by law.

DISASTER PREPAREDNESS PLAN

In the event of an emergency that affects the normal registration process of Florida vital
records, there must be a plan to handle various scenarios. The Bureau of Vital Statistics
has constructed an outline to be followed should such a situation occur.

A. Birth Certificate -- Hospital/Birthing Center
   1. Hospital is operational, but the county health department where they normally send
       the birth records is non-operational
       a. Prepare the birth certificates and Healthy Start forms as you normally would;




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                                                CHAPTER 1 – GENERAL



        b. Send the records and Healthy Start forms directly to the state office at the
            following address:
                 Bureau of Vital Statistics
                 Current Registration
                 P.O. Box 210
                 Jacksonville, FL 32231-0042
        c. Include a cover letter indicating who sent the records and a telephone number
            should there be any questions;
        d. If parents ask about obtaining certified copies, they can go to the nearest county
            office that is operational, for a birth certification, or they can contact the state
            office at 904/359-6900 ext. 9000. The vital statistics website is another option for
            obtaining certifications:
            http://www.doh.state.fl.us/planning_eval/vital_statistics/index.html
    2. Hospital forced to close for a period of time
        a. Secure any birth certificates that have been completed, but not yet mailed to the
            local office; once stable, mail to the county office, if operational, if not, mail to the
            state office at address shown above;
        b. When facility is operational, complete any outstanding birth certificates and follow
            above instructions. If parent is unavailable for signature, type mother’s name in
            item 22 and put a note on the back, in the upper right margin, indicating mother
            unavailable due to hurricane evacuation.
    3. If a birth occurs at a facility that does not normally deliver, hospital staff can contact
        the state office at 904/359-6900, either Paula Mundy at ext.1005 or Jim Ballard at
        ext. 1013.
        a. We will send some blank birth certificate forms and walk them through the
            process in getting the record completed and filed;
        b. There is a handbook on the website that goes item-by-item through the record
            and how to complete each item:
            http://www.doh.state.fl.us/planning_eval/vital_statistics/index.html
    4. State office is Non-operational
        a. If county office is open, hospitals and birthing centers should file records locally,
            as they normally would;
        b. If county office is non-operational, facility should hold completed records in
            pending file until county office or state office is operational.
NOTE: If the hospital is without power the birth certificate and Healthy Start forms may be
legibly handwritten, preferably in black ink. Hospitals should keep a supply of the blank
forms for such emergencies.

B. Death Certificate – funeral director/medical examiner
   1. Funeral home is operational, but the county office where the death certificate should
      be filed is non-operational
      a. Registrars from other counties are to accept and review these records for
          acceptability, just as they would their own;
      b. Registrars will issue certifications accordingly;
      c. Burial Transit Permits should also be filed with the nearest operational county. If
          there is no subregistrar, the CDR can issue the permit.
      d. Due to power outages, records may be handwritten, preferably in black ink.
          Please print neatly and ensure all information is legible;
      e. The operational health department will forward all records to the state office;
      f. The state office will provide local file copies for those affected counties once they
          are up and running;


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                                                CHAPTER 1 – GENERAL



         g. During this period of recovery, concerns over noncompliance for timely filing
              during this period of emergency may be suspended;
         h. Should funeral directors receive questions regarding missing persons, presumed
              dead, they should refer those questions to Ken Jones, Deputy State Registrar at
              904/359-6982 or ken_jones@doh.state.fl.us for Presumptive Death filing
    2.   Funeral home is non-operational, but has death certificates to be filed
         a. File the records with the nearest operational county office;
         b. If using a computer software package to generate the DC and have lost power,
              use the hard copy of the form;
         c. If funeral home does not have a supply of blank forms on hand, the funeral
              director should contact the nearest operational county office for forms;
         d. Due to power outages, records may be handwritten, preferably in black ink.
              Please print neatly and ensure all information is legible.
    3.   If there is no funeral director available in the disaster affected area, the closest
         operational funeral home will step in to process the paperwork as well as handle the
         remains (per Board of Funeral and Cemetery Services Emergency Preparedness
         Committee Meeting, September 25, 2007).
    4.   If death occurs in a hospital and the physician is unavailable, the funeral director
         should contact the hospital chief of staff to assist in providing the medical certification
         for a death occurring in the facility.
    5.   If death occurs at home and the physician is unavailable, the medical examiner may
         be asked to assist in providing the medical certification.
    6.   Medical Examiner has a body and the funeral home is non-operational, the ME
         should:
         a. Complete the death certificate with all available information (demographic as well
              as medical);
         b. Obtain the burial transit permit from the nearest operational county office;
         c. File the record with the nearest operational county office;
         d. If death occurs at home and the physician is unavailable, the ME may be asked
              to assist in providing the medical certification.

C. County Vital Statistics Office - If hospitals and funeral homes are affected by a natural
   disaster, such as a hurricane, chances are the local vital statistics office will also be
   affected. Normal compliance times will be relaxed in such situations. The following
   guidelines have been established to assist the local vital statistics office in establishing a
   plan of action in such occurrences.
   1. Birth Certificates – see hospital instructions.
       a. The state office will file the records received directly from the affected facility;
       b. Local file copies will be mailed to the county office once back in operation;
       c. Fatal errors encountered in the review process will be handled on a case-by-case
           basis.
   2. Death Certificates – see funeral director instructions; CDRs may issue burial transit
       permits for deaths occurring outside of their county.

D. What if state office is affected? Should the county office be operational, but the state
   office is temporarily non-operational due to a hurricane or other such disaster, the local
   office will still continue to function as follows:
   1. Review, file, and issue certifications as usual;
   2. Hold all original records until word comes from state office as to how to proceed;
   3. If office has accepted records for out of county events, be sure to maintain in
        separate file;


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                                                CHAPTER 1 – GENERAL



    4. Construct file for any amendment questions received. Forward to state office once
       operational.

Questions regarding this plan should be directed to quality assurance at the state office.




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                                    CHAPTER 2 –REGISTRATION OF LIVE BIRTHS




                   CHAPTER 2 - REGISTRATION OF LIVE BIRTHS

DEFINITION

“Live birth” is the complete expulsion or extraction from its mother of a product of
conception, irrespective of the duration of pregnancy, which after such separation, breathes
or shows any other evidence of life such as beating of the heart, pulsation of the umbilical
cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been
cut or the placenta is attached; each product of such a birth is considered live born (s.
382.002 (9), F.S.).

NEED FOR REGISTRATION

Birth records have long been a statement of facts important to the protection of individual
and property rights. Proof of age is now needed for employment, to enter school, to obtain a
driver's license, to obtain a marriage license, to register to vote, to qualify for pension and
retirement benefits, and for other purposes. Proof of parentage is needed for welfare
assistance, veteran's benefits, social security benefits to dependents and inheritance of
property. Proof of citizenship is needed for employment and for obtaining a United States
passport. The birth record is a fundamental document where proof is required of age,
citizenship, or family relationship.

STATISTICAL DATA

Birth records provide information on numbers of births and birth rates for geographical areas
and population groups. They are used to estimate and forecast family size and population
growth. Health authorities use them in planning and evaluating a broad range of health
programs, such as maternal and child health programs. Economists use birth statistics to
estimate the future size of labor force, and producers of consumer goods use them to
estimate the future market demand for their product.

BIRTH INFORMATION CONFIDENTIAL

Information contained on Florida birth records is confidential, and Florida statute and
administrative rule provide a number of safeguards to protect records from unnecessary and
indiscriminate inspection, handling, or disclosure. The hospital and parents are assured that
every legal and administrative measure possible is used to protect the child and his parents
from disclosure of confidential information. The vital statistics law specifies those persons
who are eligible to obtain copies of birth records.

RECORD TO BE FILED (S. 382.013, F.S.)

Each live birth as defined in paragraph one of this chapter must be registered in accordance
with prescribed laws and rules. If the child breathes or shows any evidence of life (per the
physician) after complete expulsion, the birth must be registered as a live birth and a death
record filed should subsequent death occur.




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                                    CHAPTER 2 –REGISTRATION OF LIVE BIRTHS



WHEN MUST A BIRTH RECORD BE FILED

Within five calendar days after the date of each birth, the hospital administrator or
designated representative of the facility where the birth occurred, or if the birth is non-
institutional, the attendant at such birth, is required to register a complete and accurate birth
record with the local registrar of the county in which birth occurred.

WHO FILES

A birth record must be filed by the hospital administrator or designated representative of the
facility where the birth occurred, physician, midwife, or other person in attendance at the
birth.

If there is no person in attendance at the birth, the father, mother, or person in charge of the
premises where the birth occurred, must report the facts of birth to the local registrar within
five days. The local registrar then has responsibility for the preparation and registration of
this record.

BIRTH RECORD - FORM (S. 382.003 (7), F.S.)

The original record of birth must be filed on a form approved by the state registrar. This
record will contain all of the items declared necessary for legal, social, and health research
purposes. There are state approved software packages for printing birth records. For
specifics on the approved packages, contact the state office.

Information concerning medical details is to be recorded on a separate section of the birth
record specifically indicated for this purpose. All original, new, or amended records of birth
are identical in form, color, size, wording, and arrangement of items, regardless of the
marital status of the parents or of the fact that the child is adopted or of undetermined
parentage.

Delayed records of birth may be on such forms as the state registrar deems proper and may
differ in format from the standard certificate.

BIRTH RECORD - SIGNATURES

Before a record can be considered to be a legal one, each birth record must bear the
signature in permanent black ink of the certifier and the initials of the local registrar or
his/her designee. In addition, it is provided by state law that at least one of the parents must
attest to the accuracy of the data which is done by signing the record after it has been
completed.


ELECTRONIC BIRTH REGISTRATION

Electronic Birth Registration (EBR) is the mechanism by which births are registered via the
Internet. It is designed to allow a hospital birth registrar to electronically enter and register a
child’s birth record, and capture and store any required signatures. This registration process
eliminates the need for hospitals to forward original hard copy birth records to county health
departments. EBR streamlines the birth registration process, making it virtually paperless,
improving customer service, and eliminating courier service for hospitals.


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                                    CHAPTER 2 –REGISTRATION OF LIVE BIRTHS




In order for the hospital and state office to ensure a record is filed for every delivery, and
that no fraudulent record is filed, the birth registrar must fax the local county vital statistics
office a labor and delivery log for the CDR to reconcile against the records entered into the
database.

Detailed information on the EBR system can be found in the EBR Hospital Manual, found on
the website at: http://www.doh.state.fl.us/planning_eval/vital_statistics/index.html How
Healthy Start operates within EBR is addressed later in this chapter.

ENUMERATION AT BIRTH

The Enumeration at Birth Program is coordinated through the Social Security Administration
(SSA). By requesting on the birth record that a social security number be issued for a child,
the SSA will issue a social security card for the child within 6 – 8 weeks of the date of birth.
This card will be helpful to the parents in filing taxes, obtaining a passport for the child,
admission to day care programs, school entrance and other programs. If the card is not
received within this timeframe, the parents should contact Social Security for a status
update on their child’s number. Should the parents need a certification, SSA requires the
certification to have the state file number.

NOTE: SSA does not issue a social security number:
  1. On a deceased child
  2. For an unnamed child through the enumeration program, but once the child is
     named, the parents can apply for the child’s number.
  3. SSA does not mail the card outside of the United States or to an overseas military
     address.

HOME BIRTHS

When a non-hospital birth or home delivery occurs, a record of live birth must be completed
and, in most cases, registered in the county where the birth occurred, provided that the first
birthday has not been reached. If the first birthday has passed, the parent should contact
the state office to obtain procedures for filing directly with that office.

Section 382.013(1) (b, c), F.S., indicates who shall prepare and register births that occur
outside a facility. In order to register a birth that occurred outside a facility, it is necessary to
verify the birth did occur; it occurred at the place and on the date reported; and the child for
whom the record is being prepared is, in fact, the child of the person to be shown as the
mother. Proof that such a birth did occur to the mother listed on the record must be
presented to the CDR before the record is accepted for registration. Section 64V-1.006,
F.A.C. provides instructions for obtaining proper documentation in such cases.

To expedite the registering of the birth, there can be a home visit by an official of the county
health department to verify the birth or the parents may bring the child to the county vital
statistics office at a pre-appointed time (the CDR must be contacted for an appointment). It
will be necessary for the parents to provide a valid signature/picture form of identification,
such as a valid unexpired driver’s license or identification card issued by the state of Florida
or any other state, and their social security card. It will be necessary to provide proof of
pregnancy.



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                                    CHAPTER 2 –REGISTRATION OF LIVE BIRTHS



There is a home birth informational packet available from the CDR. It contains statutory
requirements, information for the parents on how to get a birth record filed for their child, and
a blank affidavit.

Midwives filing birth records for home deliveries must follow the same rules as hospitals in
filing the records.

PLURAL BIRTHS

Multiple births are to be reported on separate records, and each record is to be completed in
the usual manner. If record indicates multiple births, hospital must be sure that a record is
filed for each birth. If sibling dies prior to reaching 20 weeks gestation and no record is filed,
the hospital birth registrar should make note of this on the back of the record, in the upper
right margin.

FOUNDLINGS

A birth record must be registered for every child of unknown parentage (refer to "Certificate
to be Filed" and "Who Files"). The hospital must file a record for any foundling brought to
their facility. This record should show all known or approximate facts relating to the child.
Information concerning the place and circumstances under which the child was found should
be shown. That portion of the birth record relating to medical and health details should be
completed with the available information. If needed, the reverse of the record, in the upper
right margin, can be used for any additional information.

The birth record should indicate “Unknown” in the child’s name field (item 1); the word
“Found” or “FND” should be used, along with the appropriate facts, in items for date, county,
facility name, and location, (items 3, 6, 8, 9); mother’s name should indicate “Unknown” in
the Mother’s Maiden Name field. Signature of Parent should indicate “Unavailable” all other
information should show Unknown unless it can be determined. Do not leave items blank.

In the event that a foundling child is subsequently identified to the satisfaction of the state
registrar, the state registrar makes available a record with the new information for the child.
This record bears the same file number as the original record. The record originally
prepared will be sealed and filed, not to be opened to any person except upon receipt of an
order of a court of competent jurisdiction. All local registrar copies of the original record will
be recalled by the state.




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                                    CHAPTER 2 –REGISTRATION OF LIVE BIRTHS



SURRENDERED/ABANDONED BABIES

The identity of a parent who leaves a newborn infant, seven days old or less, at a hospital or
a fire station, in accordance with s. 383.50 and 383.51, F.S., is confidential and exempt from
the provisions of s. 119.07(1), F.S. Surrendered babies come in two forms, the most
common being the newborn left at a fire station or hospital ; the other when the mother
delivers in a facility, but leaves the child, in effect surrendering the child to the facility.

    1. Newborn dropped off at fire station or hospital; there is nothing known about the
       facts of this birth - the hospital must prepare a birth record for any newborn brought
       to their facility. Items should be completed as follows:
       a. “Unknown” in the name fields – child, mother’s current surname, and father;
       b. Date of birth, item 3, should have the date the newborn was left and “Found” or
           “FND”;
       c. Place Where Birth Occurred, item 7, should have “Unknown” typed to the right of
           the home birth checkbox, do not use the term found in this item;
       d. Facility name, item 8, and City, Town or Location of Birth, item 9, should have the
           address of the fire station or hospital where the newborn was left along with the
           term Found;
       e. County of birth, item 6, should have the county where the newborn was
           abandoned and the term Found.
       f. Mother’s Maiden Name must indicate Unknown in the name field;
       g. All other information must show Unknown.
       h. Signature of Parent should indicate, Unavailable;
       i. Birth registrar should notate name of hospital completing the record and “Safe
           Haven baby” on the back of the record in the upper right margin.

    2. Newborn left at the hospital after delivery; there is information available regarding the
       delivery, but only those items directly related to the baby can be entered; the
       mother’s anonymity must be protected, as outlined in s. 383.50, F.S., none of her
       information can be used In this scenario, the mother just walks away, abandoning
       the baby at the facility. Items should be completed as follows:
           a. “Unknown” in the name fields – child, mother’s current surname, and father;
           b. Complete date, location, county, and facility name according to the facts of
               the birth;
           c. Mother’s Maiden Name must indicate Unknown in the name field;
           d. Signature of Parent should indicate, Unavailable;
           e. All other items on the record pertaining to the mother and/or father should
               indicate “unknown”.
           f. Other child related items, items 50 - 55, should be answered according to the
               information in the child’s medical record;
           g. All other items on the record should indicate “unknown”.
           h. Birth registrar should notate “Safe Haven baby” on the back of the record in
               the upper right margin.

The CDR must notify the state office immediately of any babies that fall into this category.
Include the name of the hospital, date of event and known circumstances of the birth. The
CDR should note on the back of the record, Safe Haven Baby, if not done so by the birth
registrar.




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EVIDENTIAL WEIGHT OF RECORDS

By statute, birth records, when filed in the manner and within the time limit required by law,
are prima facie evidence of the facts stated therein. Further, a certification of the original
record in the custody of the state registrar, and prepared under the seal of his office, has the
same evidential value when admitted into evidence, as does the original record.

HOSPITAL'S RESPONSIBILITY IN BIRTH REGISTRATION

It is most important that hospital staff is familiar with the vital statistics laws and regulations
on birth registration. The administrator or designated representative of the facility where the
birth occurred must certify to the fact of birth by signature before the birth record is
acceptable for registration. Physicians in attendance at institutional births may also sign
birth records, but timely registration must still be observed. Specifically, the hospital is
charged with responsibility to:

    1. Collect and record demographic and medical information as required on the birth
       record;
    2. Prepare a correct and legible record, making certain that each item on the record is
       completed before certifying the record;
    3. Any “unusual” entry on the record should have explanation on back of record;
    4. Have the mother or the father sign the record after it has been completed. If
       signature is not obtainable, type mother’s name in item 22 with an explanation on the
       back of the record.
    5. If mother is unmarried and wishes to have the father listed on the record, the hospital
       should make every effort to assist in the completion of the paternity acknowledgment
       on the front of the record, keeping in mind that the record cannot be held beyond the
       five days, waiting for the father to sign;
    6. If mother and child are brought immediately to the hospital after a home delivery,
       the hospital should prepare the record with what facts are available. The birth
       registrar should notate name of hospital completing the record on the back of the
       record, in the upper right margin.
    7. The record should then be filed in the county where the delivery occurred.
    8. Register the record with the proper local registrar within the five-day time specified.

HUSBAND TO BE SHOWN

When the mother of a child is married at the time of birth, she must list her husband as the
father of the child regardless of circumstances. Local registrars are asked to require that
such birth record be completed in accordance with these instructions.

If the mother desires to show anyone other than her husband as father of her child, she
should be advised to institute proceedings in the courts to determine the true facts of
parentage. If the court decrees that the husband is not the father and the child is thus
declared illegitimate, the decree of the court will be followed in filing or changing the birth
record.

Should a married mother refuse to supply information on her husband because he is not the
biological father of her child, the following statement should be entered on the record in item
19: “Mother refuses information on husband.” All other father information, items 20, 21,
25b, 33, 34, and 35, should indicate “Unknown.”


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If the husband dies prior to the birth of the child, the husband's name, date of birth and
birthplace may be entered on the birth certificate as father of the child in items 19 –21. “Is
Mother Married?” item 15, should, indicate “No.” A notation of “widowed” should be entered
in the upper right margin of the back of the record.

SURROGATE MOTHERS OR GESTATIONAL SURROGACY (S. 382.013, 742.16, F.S.)

The hospital birth registrar should contact the local vital statistics office Chief Deputy
Registrar for assistance in instances of gestational surrogacy. Any subsequent court action
will go through the state office.

BABIES TRANSFERRED

When an infant is born in a facility that does not normally have deliveries, e.g. emergency
delivery, and transferred to another facility, it is the responsibility of the hospital that actually
delivered to complete and file the birth record. If the receiving hospital wishes to file the
birth record, that is acceptable as long as both do not file records. It is important that the
facilities communicate with one another to avoid the possibility of duplicate records being
filed. This can become especially important if the transfer is to another county.

HEALTHY START

The Healthy Start Program is a voluntary program that provides care coordination services
to infants who are at-risk of dying in their first year of life. These at-risk infants are identified
by health and environmental factors found on the birth certificate or by a provider’s referral
found on the Healthy Start Postnatal Risk Screening Instrument,
DH 3135.

Hospitals using the Brookins Inc. software to generate the birth certificate can also generate
the Healthy Start form through Brookins. The Healthy Start scoring is automatically
calculated based on the birth certificate information. The consent checkboxes on the top of
the birth certificate and the consent items on the Healthy Start form must be consistent.
These checkboxes must be completed on every birth certificate, whether by hand or
automatically.

When completing the Healthy Start items at the top of the birth certificate it will be necessary
to have the infant’s Healthy Start Postnatal Risk Screening Instrument. Responses to the
screen consent, program consent, and info consent questions on the Healthy Start Postnatal
Risk Screening Instrument are simply transferred to the corresponding items at top of the
birth certificate. The appropriate checkbox should be marked for each item based on the
mother’s responses on behalf of the infant. It is expected that the responses at the top of
the birth certificate will be exactly the same as those found on the Healthy Start Postnatal
Risk Screening Instrument.

         Screen Consent        Y         N
         Each mother is given the opportunity to have her child screened for Healthy Start.
         When the mother consents for her infant to be screened, then “Yes” is checked on
         the Healthy Start Postnatal Risk Screening Instrument form and also for the screen
         consent on the birth certificate. If the mother does not consent to screening, then



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         “No” will be marked on the Healthy Start Postnatal Risk Screening Instrument form
         and the birth certificate for screen consent.
         Program Consent         Y        N
         The Healthy Start Postnatal Risk Screening Instrument form is used to document a
         mother’s desire for her infant to participate in Healthy Start. When a mother has
         indicated she wants her infant to participate in Healthy Start, then “Yes” should be
         checked for program consent on the Healthy Start Postnatal Risk Screening
         Instrument form and the birth certificate. Otherwise, “No” should be checked for
         program consent on both forms.
         Info Consent Y          N
         Individual information cannot be released regarding Healthy Start screening unless
         the mother consents to this release. When the mother consents for her infant’s
         information to be released, then “Yes” should be checked for info consent on the
         Healthy Start Postnatal Risk Screening Instrument form and the birth certificate.
         Otherwise, “No” should be checked for info consent on both forms.

Further information on the Healthy Start Program can be obtained from the Healthy Start
Care Coordinator in the county.

BIRTH AMENDMENTS/CORRECTIONS

Amendment, as used by the state office, is a generic term that includes a correction to a
birth record resulting from error or omission, or legal change to a birth record resulting from
an adoption, paternity action, or legal name change. Amendments can only be made by the
state office.

Fees -- Except for a Child Support Enforcement (CSE) Title IV-D, case, a fee of $20.00 is
required for an amendment made to a birth record that has been filed with the state office.
The fee includes the issuance of one certification of the amended or new record. In the
case of a CSE action, the regular certification fee of $9.00 is required if the parents want a
certification of the new record.

Birth records may be corrected at any time, in accordance with procedures set forth in
Florida Statutes and Florida Administrative Code. Refer clients to the state office.

PATERNITY ACKNOWLEDGMENT, IN-HOSPITAL

A. Paternity Acknowledgement on the front of the birth record -- in situations where the
   mother is unmarried and the father is acknowledging paternity, the acknowledgement on
   the front of the birth record is available for completion in the hospital/birthing center at
   the time of birth. Both the mother and the father’s signatures must be notarized, or
   witnessed by two witnesses, and all items completed in order for the acknowledgement
   to be valid. When using the notary, the preferred method, all rules under the notary
   statute, s. 117.05, F.S., apply. This acknowledgement can only be completed during the
   time the hospital has the original birth record; it cannot be sent to the county office for
   completion.

    Two Witness Option
    When a notary is unavailable or when the father has no acceptable identification, the
    two-witness option can be exercised as allowed in s. 742.10, F.S. The following



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    provides details related to the use of two witnesses for the in-hospital paternity
    acknowledgment:
       1. Signature Requirements and Options:
           a. Both parents must sign the acknowledgment.
           b. If either parent is a minor, the minor is encouraged to obtain the consent of
               his or her legal guardian before signing the acknowledgment. However,
               under law, a minor can sign the acknowledgment without the consent of their
               parent or legal guardian.
           c. The mother and father may not witness each other’s signature.
           d. The last name of the parents on the birth certificate and Paternity
               Acknowledgment section must match the signatures. If there is some
               discrepancy in the names, such as the Spanish tradition of two last names,
               but the names are identifiable as the same person listed, then the signature
               is acceptable.
           e. The signature is both an acknowledgment of the information and a
               verification of the information.
       2. When using the two-witness option, there are no statutory requirements related
           to either the witnesses or parents providing identification.
           a. Hospital staff can serve as witnesses and will often be personally known to
               the birth clerk or person that is facilitating the paternity acknowledgment, and
               it can be expected that at other times the parents will provide their own
               witnesses that are not personally known to hospital staff.
           b. Statute does allow minors to acknowledge paternity and have their signatures
               witnessed using this option. However, we encourage the use of a notary
               public in situations involving minors signing legal documents.
           c. If parents provide witnesses that are willing and able, hospital staff cannot
               refuse to facilitate the paternity acknowledgment based upon a lack of
               identification for any of the parties. However, we encourage hospital staff to
               use good judgment when they are themselves serving as witness to parental
               signatures.
           d. If any prospective witness is uncomfortable witnessing any individual
               signature because of the lack of identification, the birth clerk (or other person
               facilitating the paternity acknowledgment) should consider the use of another
               witness, if available or notary public instead.

The hospital must provide the parents with the information sheet, “What You as a Parent
Must Know before Signing This Acknowledgement”. They should read this information
before signing the Paternity Acknowledgment. Copies of this information sheet can be
obtained from the Chief Deputy Registrar or on our website at:
http://www.doh.state.fl.us/planning_eval/vital_statistics/template3.htm

There is also the Florida In-Hospital Paternity Establishment Resource Guide, a Child
Support Enforcement (CSE) document to assist the birth registrar when dealing with in-
hospital paternity issues. A copy of this guide can be obtained from the chief deputy
registrar or local CSE coordinator.

B. Paternity establishment after birth record is filed:
      1. If, at any time after the birth of a child born to an unmarried mother, both parents
          wish the name of the father, as well as other particulars included on the birth
          record, the local registrar should refer the parents to the state office where a new
          birth record can be filed through the amendment process;


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        2. The registrar must keep a supply of the Acknowledgement of Paternity, DH 432,
            and the Application for Amendment to Florida Birth Record, DH 429 form to
            provide to those parents requesting to add a father after the original record has
            been filed;
        3. Once the proper paperwork is filed and accepted, the original record, together
            with any related papers, are retained;
The local registrar's copy of the old record is recalled – it is crucial that these documents are
pulled from the county files immediately upon request of the state office to prevent
accidental issuance of a document.

Detailed instructions on the proper completion of the paternity acknowledgement can be
found in Chapter 3, Preparing the Birth Certificate. Another good resource is the Child
Support Enforcement (CSE) Resource Guide which can be obtained from the local CSE
coordinator or on the department’s vital statistics Intranet web site at: http://dohiws/

PROSPECTIVE ADOPTIONS - NEW BIRTHS

The preparer of the record should note all prospective adoptions as, “adoption,” on the back
of the birth record, in the upper right margin.

LATE REGISTRATION OF BIRTHS

Birth registration for a child under one year of age that was not done at the time of birth may
be registered and processed by the local registrar, using the regular standard birth record
and in the same manner as current records. An explanation for the lateness should be
shown on the back of the record, in the upper right margin.

DELAYED BIRTH RECORDS

A fee paid search of state office files must officially determine that the birth of a child over
one year of age has never been recorded; then a delayed birth record may be filed if
sufficient evidence can be obtained. This must be done in accordance with procedures set
forth in Florida Statutes and Florida Administrative Code, and an additional filing fee is
required. Local registrars are requested to refer inquiries concerning this procedure to the
state office.

BIRTH OCCURRING IN ANOTHER REGISTRATION DISTRICT/COUNTY

Local registrars are not to accept nor forward to the state office records for births not
occurring in the registrar's county.




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NON-FLORIDA BIRTH

The local registrar may not register records of births not occurring in this state. The state
registrar may file birth records for foreign-born children adopted by U.S. citizens who live in
Florida. Questions regarding foreign adoptions should be referred to the Adoption Unit at
the state office.

BIRTHS THAT OCCURRED IN OTHER STATES, OUTLYING U.S. AREAS, AND
OVERSEAS BIRTHS INVOLVING U.S. NATIONALS

The U.S. Public Health Service, Centers for Disease Control, National Center for Health
Statistics (NCHS) maintains information on where to write for information regarding other
states etc. It is available on their Internet website at: cdc.gov/nchswww. This is an
excellent source of information on this subject for use by registrars.

Births occurring overseas involving U.S. nationals may not be registered in the State of
Florida. Information on foreign births of U.S. citizens can be found in the attachments of this
handbook. Inquiries may be referred to the state office. For a foreign adoption by a Florida
resident, the department will, upon request of the adoptee or the adopting parent, prepare
and file a birth record upon receipt of a certified copy of the adoption decree
(s. 382.017, F.S.).




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                             CHAPTER 3 – PREPARING THE CERTIFICATE OF LIVE BIRTH



      CHAPTER 3 - PREPARING THE CERTIFICATE OF LIVE BIRTH

HEALTHY START ITEMS

The Healthy Start Program is a voluntary program that provides care coordination services
to infants who are at-risk of dying in their first year of life.

The appropriate checkbox should be marked for each item based on the mother’s
responses on behalf of the infant. It is expected that the responses at the top of the birth
certificate will be exactly the same as those found on the Healthy Start Postnatal Risk
Screening Instrument.

         Screen Consent          Y        N
         Each mother is given the opportunity to have her child screened for Healthy Start.
         When the mother consents for her infant to be screened, then “Yes” is checked on
         the Healthy Start Postnatal Risk Screening Instrument form and also for the screen
         consent on the birth certificate. If the mother does not consent to screening, then
         “No” will be marked on the Healthy Start Postnatal Risk Screening Instrument form
         and the birth certificate for screen consent.

         Program Consent       Y      N
         When a mother has indicated she wants her infant to participate in Healthy Start,
         then “Yes” should be checked for program consent on the Healthy Start Postnatal
         Risk Screening Instrument form and the birth certificate. Otherwise, “No” should be
         checked for program consent on both forms.

         Info Consent Y         N
         Individual information cannot be released regarding Healthy Start screening unless
         the mother consents to this release. When the mother consents for her infant’s
         information to be released, then “Yes” should be checked for info consent on the
         Healthy Start Postnatal Risk Screening Instrument form and the birth certificate.
         Otherwise, “No” should be checked for info consent on both forms.


             DEMOGRAPHIC PORTION OF THE LIVE BIRTH CERTIFICATE

Items 1 – 22, through the Signature of Parents, are contained in what is termed the "legal"
portion of the birth certificate. These items are necessary for the identification of the
individual and for a description of where and when the birth occurred. These are the items
of information that are furnished when a person requests a certified copy of his/her birth
certificate. All other information is considered statistical in nature and not part of the
certification

1. CHILD'S NAME (First, Middle, Last)

Enter and space out the child's first, middle and last names, and suffix, if applicable, in this
item. Names should be spaced in a reasonable manner so that the last name of the child
can be easily identified. It is suggested that there be three spaces between each name field




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and one space between each name in the same field,
e.g. Paula Jean Ella Mae Smith Barney. Do not abbreviate.

If the parents do not have given names selected for the child, enter the last name only to the
far right of the field, allowing sufficient room to add names at a later date. Never enter
"Baby Girl" or "Infant Boy," etc.

If the mother is married at the time of birth, the mother and father listed on the birth
certificate shall select the surname of the child or the parent who will have custody of the
child shall select the surname. This is true unless the surname has been decreed by a court
of competent jurisdiction.

If the mother is not married at the time of birth, the person who shall have custody of the
child (in most cases, this will be the mother) shall select the surname of the child. If the
father of the child born to an unmarried woman wishes to claim paternity, this may be done
by the completion of the paternity acknowledgement on the front side of the birth certificate.

For cases in which parents wish to enter multiple names it is suggested that a first name,
and last name be entered as provided in item 1, then above the name: "additional names
recorded on back." The additional names should be neatly entered on the back of the
certificate, in the upper right margin.

If parents disagree on the surname of the child and have joint custody, the surname
selected by the mother and the surname selected by the father will appear in alphabetical
order separated by a hyphen. If parents disagree on the given names of the child and have
joint custody, the given names will not be entered on the birth certificate until a joint written
agreement is supplied to the department (state office) of the selection of the given names.

Entries of Jr (Junior), Sr (Senior), I (first), II (second), III (third), IV (fourth), V, (fifth) etc.,
following the last name are acceptable. Do not use periods.

THIS ITEM IDENTIFIES THE INDIVIDUAL FOR WHOM THE CERTIFICATE IS BEING
PREPARED.

2. SEX

Enter male or female. Do not abbreviate or use other symbols. If sex and name are
inconsistent, verify both entries. If sex cannot be determined after verification with medical
records, mother of child, informant, or other sources, enter “Unknown”, and note on back of
record, upper right margin, that the sex is undetermined.

THIS ITEM AIDS IN IDENTIFICATION OF THE CHILD. IT IS ALSO USED IN ESTIMATING
POPULATION AND FOR STATISTICAL RESEARCH.




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3. DATE OF BIRTH (Month, Day, Year) (Child)

Enter the exact month, day, and year the child was born. Enter the full or abbreviated name
of the month (Jan., Feb., March, etc.). Do not use a number for the month. Pay particular
attention to the entry of month, day, and year when the birth occurs around midnight or on
December 31. Consider a birth at midnight to have occurred at the beginning of one day
rather than at the end of the previous day.

If the child is a foundling or abandoned baby, the word “Found” or “FND” should be entered
along with the date of birth for those babies left at a fire station or hospital. Do not use the
term if the mother simply leaves the baby at the hospital where she delivered.

THIS ITEM RECORDS THE DATE OF BIRTH OF THE INDIVIDUAL NAMED ON THE
CERTIFICATE. IT IS USED TO ESTABLISH AGE FOR SUCH PURPOSES AS SCHOOL
ENTRANCE, OBTAINING A DRIVER'S LICENSE, SOCIAL SECURITY BENEFITS, ETC. IT
IS ALSO USED TOGETHER WITH DATE OF LAST NORMAL MENSES TO ESTABLISH
LENGTH OF GESTATION FOR HEALTH STATISTICS AND RESEARCH STUDIES.

4. BIRTH WEIGHT

Enter the birth weight of the child as it is recorded on the hospital record, either measured in
pounds and ounces or grams – do not enter both; do not convert. Do not enter fractions or
decimals, e.g. if the weight is 6 lbs. 4 ½ oz, round up to 6 lbs 5 oz or if weight is 7 lbs 3.3 oz,
round down to 7 lbs 3 oz. When using pounds and ounces and there are no ounces you
must still enter something in that space, e.g. 7 lbs. 0 oz. This system of measurement is
based on NCHS recommendation.

THIS IS THE SINGLE MOST IMPORTANT CHARACTERISTIC ASSOCIATED WITH
INFANT MORTALITY. IT IS ALSO RELATED TO PRENATAL CARE, SOCIOECONOMIC
STATUS, AND OTHER FACTORS SURROUNDING THE BIRTH AND CONSEQUENTLY,
IS USED WITH OTHER INFORMATION TO PLAN FOR AND EVALUATE THE
EFFECTIVENESS OF HEALTH CARE.

5. TIME OF BIRTH

Time of birth should be recorded in the 24 hour clock format. Enter the exact time the child
was born, according to local time. If daylight savings time is the official prevailing time when
birth occurs, it should be used to record the time of birth. Enter 12 noon as "1200". One
minute after 12 noon is entered as "1201". Enter 12 midnight as "0000". One minute after
12 midnight is entered as "0001". Remember that midnight is the beginning of the new day.

In cases of plural births, the exact time each child is delivered should be recorded as the
hour and minute of birth for that child.

THIS ITEM DOCUMENTS THE EXACT TIME OF BIRTH FOR VARIOUS LEGAL USES
SUCH AS THE ORDER OF BIRTH IN PLURAL BIRTHS. WHEN THE BIRTH OCCURS
AROUND MIDNIGHT, THE EXACT HOUR AND MINUTE MAY AFFECT THE DATE OF
BIRTH. FOR BIRTHS OCCURRING AT THE END OF THE YEAR, THE HOUR AND
MINUTE AFFECT NOT ONLY THE DAY BUT THE YEAR OF BIRTH, A FACTOR IN
ESTABLISHING DEPENDENTS FOR INCOME TAX PURPOSES. IT IS ALSO OFTEN AN
ITEM OF PERSONAL INTEREST TO THE PARENTS AND LATER TO THE INDIVIDUAL.


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6 - 9 PLACE OF BIRTH

If the child was a foundling or abandoned baby, the word “Found” or “FND” should be
entered in these items for those babies left at a fire station or hospital (exception is item 7
where Unknown is all that should be entered). Do not use the term if the mother simply
leaves the baby at the hospital where she delivered.

6. COUNTY OF BIRTH

Enter the name of the county where the birth occurred. For births occurring on a moving
conveyance, enter county where the child was first removed from the conveyance. If the
birth occurred in international waters or airspace, contact the state office for instructions.

THESE ITEMS IDENTIFY THE PLACE OF BIRTH. PROOF OF PLACE OF BIRTH IS
NECESSARY ANYTIME A PERSON IS CALLED UPON TO PROVE THAT HE OR SHE IS
A CITIZEN OF THE UNITED STATES. PLACE OF BIRTH INFORMATION TOGETHER
WITH RESIDENCE INFORMATION PROVIDES DATA TO EVALUATE THE SUPPLY AND
DISTRIBUTION OF OBSTETRICAL SERVICES.

7. PLACE WHERE BIRTH OCCURRED

Mark the line that applies to the type of place where the birth occurred. A birthing center
located in and operated by a hospital is considered part of the hospital and should be
reported as occurring in the hospital. Freestanding birthing centers include those facilities
that are operated independently from hospitals. The "clinic/doctor's office" category includes
other non-hospital outpatient facilities where births usually occur.

If the birth occurs in a penal institution, check “Other (Specify) and enter Public Building.

For “EN ROUTE” births, “Other (Specify)” should be checked and enter the phrase “EN
ROUTE.” Any other related information should be entered on the back of the record in the
upper right margin, e.g. father delivered baby in car on way to hospital.

Indicate if this was a home birth and if it was a planned or unplanned delivery at home.

If a foundling or abandoned baby, enter Unknown to the right of the home birth checkbox.

THIS ITEM IDENTIFIES HOME BIRTHS, BIRTHS IN FREESTANDING BIRTHING
CENTERS, AND BIRTHS IN NONHOSPITAL CLINICS OR PHYSICIANS' OFFICES. SUCH
INFORMATION PERMITS ANALYSIS OF THE NUMBER AND CHARACTERISTICS OF
BIRTHS BY TYPE OF FACILITY AND IS HELPFUL IN DETERMINING THE LEVEL OF
UTILIZATION AND CHARACTERISTICS OF BIRTHS OCCURRING IN SUCH FACILITIES.




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8. FACILITY NAME (If not institution, give street and number)

Enter the name of the facility where birth occurred. When birth occurs in a mental hospital
or penal institution; enter the street address of the facility and put a note on the back of the
record in the upper right margin, indicating the name of the facility/institution. If the birth
occurred on a moving conveyance en route to or on arrival at a facility, the name of the
facility should be entered.

If the birth occurred at home (home is considered any residence), enter the house number
and street name of the place where birth occurred. If the birth occurred at some place other
than those described above, enter the number and street name of the location. If there is no
street address, give best geographical description of the place that will assist in identifying
the exact location.

If birth occurred on a moving conveyance other than en route to a facility, enter as the place
of birth the address where the child was first removed from the conveyance.

THE FACILITY NAME IS USED FOR FOLLOW-UP AND QUERY PROGRAMS IN THE
STATE OFFICE AND IS OF HISTORICAL VALUE TO THE PARENTS AND CHILD. IT
MAY ALSO BE USED TO PRODUCE STATISTICAL DATA BY SPECIFIC FACILITY.

9. CITY, TOWN OR LOCATION OF BIRTH

Enter the name of the city, town, or location where the birth occurred.

For births occurring on a moving conveyance in international waters or international
airspace, or in a foreign country or its airspace and the baby was first removed from the
conveyance in this state, enter “Sea/Air” for the city.

10 - 13. CERTIFIER/ATTENDANT INFORMATION

If the certifier, item 10, and the attendant, item 12, are the same, both items must be
completed on the record.

10. CERTIFIER’S SIGNATURE AND TITLE

Obtain the signature of the hospital administrator or designated representative, if an
institutional birth, or the physician certified nurse midwife, licensed midwife or other person
in attendance at the birth. Check the box that reflects the title of the person who signs.

         M.D. - doctor of medicine
         D.O. - doctor of osteopathy
         C.N.M. - certified nurse midwife
         L.M. - licensed midwife
         Hospital Admin. - hospital administrator
         If "Other (Specify)" is checked, type the title of the certifier in the space provided.

THIS ITEM PROVIDES INFORMATION ABOUT THE CERTIFIER AND INDICATES THE
TYPE OF PERSON WHO ATTENDED THE BIRTH WHEN THE CERTIFIER IS THE
ATTENDANT.



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11. DATE SIGNED (Month, Day, Year)

Enter the date the certifier signed the certificate. Do not back date. Enter the full or
abbreviated name of the month. Do not use a number to designate the month.

12. ATTENDANT'S NAME and TITLE

Enter the name of the attendant at birth. Check the appropriate line to identify his/her title:

         M.D. - doctor of medicine
         D.O. - doctor of osteopathy
         C.N.M. - certified nurse midwife
         L.M. - licensed midwife
         If "Other (Specify)" is checked, type or print the title of the attendant in the space
         provided and that person’s relationship to the child. If an unmarried mother and the
         father deliver the baby, use the term Father only if the paternity acknowledgment has
         been completed, other wise, enter Friend.

THE ATTENDANT'S NAME IS IMPORTANT IN CASE OF QUERIES. THE TITLE
PROVIDES INFORMATION ON THE TYPE OF ATTENDANT, WHICH IS USED TO
ASSESS THE SERVICE RENDERED. THIS INFORMATION WILL PERMIT SEPARATE
IDENTIFICATION OF DELIVERIES ATTENDED BY CERTIFIED NURSE MIDWIVES,
LICENSED MIDWIVES, AND OTHER PERSONS.

13. DATE FILED BY REGISTRAR (Month, Day, Year) (Reg. Initials)

This item will be completed by the local, deputy, or state registrar when the certificate is
received. The date entered should be the actual date the record was received in the county
vital statistics office. Do not use a number to designate the month. The CDR should initial
this item after record has been reviewed and accepted for registration.

THE DATE DOCUMENTS WHETHER THE BIRTH CERTIFICATE WAS REGISTERED
WITHIN FIVE CALENDAR DAYS AFTER BIRTH (s. 382.013, F.S.).

14a. MOTHER'S MAIDEN NAME (First, Middle, Maiden)

Enter the first, middle, and maiden last names of the mother. If maiden name is not known,
enter Unknown.

If the child is a foundling, the word “foundling” should be entered in the mother’s maiden
name field. If the child is an abandoned baby, the words “abandoned baby” should be
entered in the mother’s maiden name field.




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14b. MOTHER'S CURRENT SURNAME, IF DIFFERENT THAN 14a.

Enter the current surname of the mother if different from that entered in 14a. If child is either
a foundling or an abandoned baby, enter “Unknown.”

THESE ITEMS ARE DOCUMENTARY EVIDENCE OF PARENTAGE. THE MOTHER'S
MAIDEN NAME IS AN IMPORTANT PART OF AN INDEX TO A BIRTH FILE. IT IS
ESPECIALLY USEFUL SINCE THE MAIDEN NAME REMAINS CONSTANT, EVEN
THOUGH THE LAST NAME OF THE INDIVIDUAL BEING REGISTERED AND THE
MOTHER'S MARRIED NAME MAY CHANGE SEVERAL TIMES.

15. IS MOTHER MARRIED?

Enter "Yes" if the mother is married at the time of birth. Otherwise, enter "No". Remember,
a woman is married even if she is legally separated.

If the husband dies prior to the birth of the child, the husband's information may be entered
on the record in all items related to the father. “Is Mother Married?” item 15, should, indicate
“No.” A notation of “widowed” should be entered in the upper right margin of the back of the
record.

THIS INFORMATION IS NEEDED TO STUDY THE SOCIAL PROBLEMS RELATED TO
OUT-OF-WEDLOCK BIRTHS. IT IS EVEN MORE IMPORTANT AS A TOOL IN STUDYING
HEALTH PROBLEMS OF THESE CHILDREN AND THEIR MOTHERS; FOR EXAMPLE,
WHETHER THESE CHILDREN ARE OF LOWER BIRTH WEIGHT, HAVE HIGHER INFANT
MORTALITY, OR ARE BORN TO MOTHERS WITH LESS PRENATAL CARE.

16. DATE OF BIRTH (Month, Day, Year) (Mother)

Enter the exact month, day, and year that the mother was born. Enter the full or abbreviated
name of the month. Do not use a number to designate the month.

THIS ITEM IS USED TO CALCULATE THE AGE OF THE MOTHER, WHICH IS ONE OF
THE MOST IMPORTANT FACTORS IN THE STUDY OF CHILDBEARING AND
CONSEQUENTLY IS WIDELY USED IN DEVELOPING STATISTICAL DATA. FOR
EXAMPLE, STUDIES HAVE BEEN DONE TO SHOW THE RELATIONSHIP OF THE
HEALTH OF THE CHILD AND AGE OF THE MOTHER.

17. BIRTHPLACE (State, Territory or Foreign Country)

If the mother was born in the United States, enter the name of the state. If the mother was
born in Canada, enter the name of the Province, Canada, e.g. Vancouver, British Columbia.
If the mother was born in another foreign country or a U.S. territory, enter the name of the
country or territory. If the mother was born in the United States, but the state is unknown,
enter "Unknown.” If the mother was been born in a foreign country, but the country is
unknown, enter "Unknown." If no information is available regarding place of birth, enter
"Unknown.”

THIS ITEM IS USED WITH THE CENSUS DATA TO COMPARE CHILDBEARING OF
WOMEN WHO RESIDE IN THE STATE WHERE THEY WERE BORN WITH THAT OF
WOMEN WHO RESIDE IN A STATE OTHER THAN THEIR STATE OF BIRTH.


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18a-g. MOTHER'S RESIDENCE

Mother's residence is the place where she has set up housekeeping. This is not necessarily
the same as her "home state", "voting residence", "mailing address", or "legal residence".
Never enter a temporary residence such as one used during a visit, business trip, or a
vacation. Residence for a short time at the home of a relative, friend, or home for unwed
mothers for the purpose of awaiting the birth of a child is considered to be temporary and
should not be entered here. Place of residence during a tour of military duty or during
attendance at college is not considered as temporary and should be considered as place of
residence of mother for entry on the certificate.

Do not enter a Post Office Box as the mother’s residence. If the location has no number
and street name, enter the rural route number and box number, or a geographical
description of place that will aid in identifying the precise location

18a. MOTHER’S RESIDENCE - STATE

Enter the name of the state in which the mother resides. This may differ from the state used
in her mailing address. If the mother lives in a foreign country, enter the name of the
country.

18b. COUNTY

Enter the name of the county in which the mother resides. If the mother lives in Canada,
enter the name of the Province. If the mother lives in another foreign country this item
should be left blank.

18c. CITY, TOWN, OR LOCATION

Enter the name of the city, town, or location where the mother resides. This may differ from
the city, town, or location used in her mailing address.

18d. STREET AND NUMBER (Include Apt. No.)

Enter the house number and street name of the place where the mother resides. It is
important to include any street indicators, e.g., N., N.W., etc. (Example: 126 S.E. Broadway
Ct.). If this location has no number and/or street name, enter the rural route number or a
geographical description of the place that will aid in identifying the precise location. Never
enter a Post Office Box.

18e. ZIP CODE

Enter the zip code that corresponds with the address in items 18a-18d. If it is a foreign
address, leave item blank. A U.S. zip code is required for mailing of a social security card.

18f. INSIDE CITY LIMITS?

Enter "Yes" if the location entered in item 18d (Street and number) is within the city limits of
18c (City, Town, or Location). Otherwise, enter "No."



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MOST STATISTICS ON BIRTHS ARE TABULATED BY PLACE OF RESIDENCE OF THE
MOTHER. THIS MAKES IT POSSIBLE TO COMPUTE BIRTH RATES BASED ON THE
POPULATION RESIDING IN THE AREA. BIRTHS BY PLACE OF RESIDENCE OF THE
MOTHER ARE USED TO PREPARE POPULATION ESTIMATES AND PROJECTIONS.
THESE DATA ARE USED IN PLANNING FOR EVALUATING COMMUNITY SERVICES
AND FACILITIES, INCLUDING MATERNAL AND CHILD HEALTH PROGRAMS,
SCHOOLS, ETC. PRIVATE BUSINESSES AND INDUSTRIES ALSO USE THESE DATA
FOR ESTIMATING DEMANDS FOR SERVICES.

18g. MOTHER'S MAILING ADDRESS

Enter the mailing address of the mother only if it is different from the residence address. If it
is the same, mark “check here if same.” It is important to distinguish between the mother's
mailing address and her residence address when they are different, as each serves a
different purpose and they are not substitutes for one another.

A U.S. zip code is required for mailing of a social security card. Foreign and military
overseas addresses may not be used.

THIS ITEM IS USED TO MAIL A BIRTH NOTIFICATION RECORD, SOCIAL SECURITY
CARD FOR CHILD (IF ENUMERATION AT BIRTH WAS DESIRED), AND TO ASK THE
MOTHER FOR CLARIFICATION OF BIRTH CERTIFICATE ENTRIES, WHEN NEEDED. IT
IS ALSO USED FOR FOLLOW-BACK STUDIES TO OBTAIN ADDITIONAL INFORMATION
ABOUT THE BIRTH.

19. FATHER's NAME (First, Middle, Last)

    1. If the child was born to a mother who was married at the time of birth:
            a. Enter the name of her husband, or
            b. If the husband dies prior to the birth of the child, the husband's name may be
               entered on the birth certificate as father of the child and marital status, item
               15 should, indicate “No.”
            c. A married mother refuses to give information on her husband, the birth
               certificate should be completed as follows: Item 15 "Is mother married?"
               should be completed as "yes." In items 19 (Father information) the following
               statement should be entered: "Mother refuses information on husband.”
               Other items, 20,,21, 25b, 33, 34, and 35, associated with the father should be
               shown as “Unknown”. NOTE: If the husband is present and states he wants
               to be listed on the record as the father, his name must be entered as such.
    2. If the child was born to an unmarried mother:
            a. Make no entry regarding the father’s name and omit all father related items.
               All father information should be left blank, or
            b. If the father has acknowledged paternity as previously outlined, items 19-21,
               and any other father items will be completed, or
            c. If the child was conceived by means of artificial insemination, “Artificial
               Insemination Donor” may be entered in item 19, the father’s name field, or the
               father information is left blank and artificial insemination may be listed in item
               43, History Factors for this Pregnancy.

ITEM NEEDED FOR IDENTIFICATION AND AS DOCUMENTARY EVIDENCE OF
PARENTAGE.


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20. FATHER’S DATE OF BIRTH (Month, Day, Year)

Enter the exact month, day, and year that the father was born. Do not use a number to
designate the month. Enter the full or abbreviated name of the month. Remember, a child
born at midnight is born at the beginning of the day.

AGE IS USED IN THE STUDY OF CHILDBEARING AND HEALTH.

21. FATHER’S BIRTHPLACE (State, Territory or Foreign Country) (Father)

If the father was born in the United States, enter the name of the state. If the mother was
born in Canada, enter the name of the Province, Canada, e.g. Vancouver, British Columbia.
If the father was born in a foreign country or a U.S. territory, enter the name of the country or
territory. If the father was been born in the United States, but the state is unknown, enter
"Unknown." If the father was born in a foreign country, but the country is unknown, enter
"Unknown." If no information is available regarding place of birth, enter "Unknown."

THIS IS A STATISTICAL ITEM USED WITH CENSUS DATA TO STUDY BIRTHS OF
CHILDREN WHO’S FATHERS, AT THE TIME OF BIRTH OF THE CHILD, RESIDED IN
THE STATE WHERE THEY WERE BORN AND CHILDREN WHOSE FATHERS RESIDED
IN A STATE OTHER THAN THEIR STATE OF BIRTH.

22. INFORMANT STATEMENT AND SIGNATURE - I CERTIFY THAT THE PERSONAL
INFORMATION PROVIDED ON THIS CERTIFICATE IS CORRECT TO THE BEST OF MY
KNOWLEDGE. SIGNATURE OF PARENT:

Obtain the signature of the parent who provided the personal facts after the information has
been entered on the certificate and reviewed by such person.

If there is no parent available to sign the record (mother transferred to another facility or is in
a coma, deceased, etc.) the name should be typed in item 22 and a brief note written on the
back of the record, in the upper right margin, stating, “Mother unavailable to sign record”.

If the record is for an abandoned baby or a foundling, enter “abandoned baby” or “foundling”
in place of the mother’s signature.

THE CERTIFICATION VALIDATES THE ACCURACY OF THE INFORMATION
RECORDED ON THE CERTIFICATE AND IS SPECIFICALLY MANDATED BY STATE
LAW.


                                  PATERNITY ACKNOWLEDGMENT

In situations where the mother is unmarried and the father is acknowledging paternity, the
paternity acknowledgement on the front of the birth certificate is available for completion at
the time of birth. Both the mother’s and the father’s signatures must be notarized or signed
before two witnesses and all items completed in order for the acknowledgment to be valid.
When using the notary, the preferred method, all rules covered under the notary statute,
s. 117.05, F.S., apply.



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A good resource on paternity acknowledgment is the Child Support Enforcement (CSE)
Resource Guide which can be obtained from the CSE Coordinator.

TWO WITNESS OPTION

When a notary is unavailable or the father has no identification, the two-witness option can
be exercised as allowed in s. 742.10, F.S. The following provides details related to the use
of two witnesses for the in-hospital paternity acknowledgment:

    1. Signature Requirements and Options:
       a. Both parents must sign and date the acknowledgment.
       b. If either parent is a minor, the minor is encouraged to obtain the consent of his or
           her legal guardian before signing the acknowledgment. However, under law, a
           minor can sign the acknowledgment without the consent of their parent or legal
           guardian.
       c. The mother and father may not witness each other’s signature.
       d. The last name of the parents on the birth certificate and Paternity
           Acknowledgment section must match the signatures. If there is some
           discrepancy in the names, such as the Spanish tradition of two last names, but
           the names are identifiable as the same person listed, then the signature is
           acceptable.
       e. The signature is both an acknowledgment of the information and a verification of
           the information.
    2. When using the two-witness option, there are no statutory requirements related to
       either the witnesses or parents providing identification.
       a. Hospital staff can serve as witnesses and will often be personally known to the
           birth clerk or person that is facilitating the paternity acknowledgment, and it can
           be expected that at other times the parents will provide their own witnesses that
           are not personally known to hospital staff.
       b. Statute does allow minors to acknowledge paternity and have their signatures
           witnessed using this option. However, we encourage the use of a Notary Public
           in situations involving minors signing legal documents.
       c. If parents provide witnesses that are willing and able, hospital staff cannot refuse
           to facilitate the paternity acknowledgment based upon a lack of identification for
           any of the parties. However, we encourage hospital staff to use good judgment
           when they are themselves serving as witness to parental signatures.
       d. If any prospective witness is uncomfortable witnessing any individual signature
           because of the lack of identification, the birth clerk (or other person facilitating the
           paternity acknowledgment) should consider the use of another witness, if
           available or notary public instead.

The birth record cannot be held beyond the required five-day filing period, waiting for a
father to acknowledge paternity. If the father is unavailable to sign the in-hospital paternity,
the hospital should provide the mother with the form DH 432, Acknowledgement of
Paternity, which can be filed directly with the state office at any time after the birth of the
child. A supply of this form is available at the county vital statistics office.

23. FATHER’S ADDRESS

Enter the residence address of the father acknowledging paternity.



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                                  FOR ADMINISTRATIVE USE ONLY

The following information is for administrative use only and is not part of any certification.

24. SOCIAL SECURITY NUMBER REQUESTED FOR CHILD

The Enumeration at Birth program allows parents to request a social security number be
issued for child through the birth registration process. The state office transmits information
to the Social Security Administration who in turn mails the parents a social security card as
requested for their child.

Certain situations require “No” to be checked. If the child:

    1.   Is unnamed
    2.   Is to be placed for adoption
    3.   Is critically ill and not expected to survive
    4.   Has died prior to completion of birth certificate

There are some instances when the parents request a number to be assigned for their child,
but they do not receive the card in the mail. These cases may be due to Social Security’s
computer program limitations that prevent printing a card automatically, e.g. use of numerals
or special characters in the name, or undeliverable mailing addresses (no U.S. zip code or
overseas military). The parents should contact Social Security for them to process the
request manually.

25a. and 25b. MOTHER AND FATHER SOCIAL SECURITY NUMBER(S)

Enter the social security numbers of each parent. If parents refuse to give their social
security numbers, complete this item with Unknown. If parent(s) do not have a social
security number, enter None or Unknown.

THE SOCIAL SECURITY NUMBERS NEVER APPEAR ON CERTIFIED COPIES OF THE
BIRTH CERTIFICATE. THE DEPARTMENT OF HEALTH’S COLLECTION OF THE
SOCIAL SECURITY NUMBER IS AUTHORIZED BY FEDERAL LAW, PUBLIC LAW (PL)
105-34, SECTION 1090.

26. PRINCIPAL SOURCE OF PAYMENT FOR THIS DELIVERY

Check the appropriate entry of “private insurance,” “Medicaid,” “self pay,” or” other-specify.”
Some examples of “Other” would be Champus/Tricare or Indian Health. An HMO or PPO is
considered as private insurance.

THIS INFORMATION IS USED FOR PUBLIC HEALTH PURPOSES SINCE IT HAS BEEN
SHOWN THAT THERE ARE DISTINCT DIFFERENCES IN SOCIO-ECONOMIC STATUS
AND BIRTH OUTCOMES AMONG PAYMENT CATEGORIES.

27. DID MOTHER GET WIC FOOD FOR HERSELF DURING THIS PREGNANCY




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WIC is the Department of Agriculture’s nutrition program for Women, Infants and Children.
WIC provide pregnant women and/or their children formula, food, checks or vouchers for
food.

Check “No” if the mother did not get WIC food for herself during this pregnancy; check “Yes”
if she participated in the WIC program.

NUTRITION IS AN IMPORTANT FACTOR IN IMPROVING PREGNANCY OUTCOME FOR
BOTH MOTHER AND CHILD.

28a. WAS MOTHER TRANSFERRED FOR MATERNAL MEDICAL OR FETAL
INDICATIONS FOR DELIVERY (If “Yes,” specify name of facility transferred from)

Check “No” if this is the first facility to which the mother was admitted for this delivery or if
delivery took place at home and mother came to the facility right after delivery. Check “Yes”
if the mother was transferred from one facility to another facility before the child was
delivered.

If the mother was transferred before the delivery, enter the name of the facility from which
she was transferred, e.g. mother started labor at freestanding birthing center, but was taken
to the hospital for the delivery. If the mother was transferred more than once, enter the
name of the last facility from which she was transferred.

THIS INFORMATION IS USED TO STUDY TRANSFER PATTERNS AND DETERMINE
WHETHER TIMELY IDENTIFICATION AND MOVEMENT OF HIGH-RISK PATIENT IS
OCCURRING.

28b. WAS INFANT TRANSFERRED WITHIN 24 HOURS OF DELIVERY (If “Yes,”
specify name of facility transferred to)

Check “No” if the infant was not transferred to another facility. Check “Yes” if the infant was
transferred from this facility to another facility after delivery. If the infant was transferred,
enter the name of the facility to which the infant was transferred. If the infant was
transferred more than once, enter the name of the first facility to which the infant was
transferred.

THIS INFORMATION IS USED TO EXAMINE TRANSFER PATTERNS AND PERINATAL
OUTCOMES BY THE TYPE OF HOSPITAL OR LEVEL OF CARE. IT MAY ALSO BE
USED TO FOLLOW UP AND DETERMINE THE SURVIVAL STATUS OF AN INFANT
TRANSFERRED TO A DIFFERENT FACILITY.

29a. IS INFANT LIVING AT TIME OF REPORT (If “No,” complete items 29b-29c)

Check “Yes” if the infant is alive at the time of preparation of the birth certificate. Check “No”
if the infant has died then complete items 29b and 29c. Check “Infant transferred, status
unknown” if the infant was transferred and the status is unknown.

If the facility notifies the county of the death of the infant after they have filed the record, the
CDR should put a note on back in upper right margin, indicating deceased. Include the date
of death if known.



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29b. DATE OF DEATH (Month, Day, Year)

Enter the Month, Day, and Year the infant died. Enter the full or abbreviated name of the
month. Do not use numerical entry.

29c. COUNTY OF DEATH

Enter the county where the death occurred.

ITEMS 29A-29C PROVIDE INFORMATION ON THE STATUS OF THE INFANT AT THE
TIME THE BIRTH CERTIFICATE IS PREPARED. COMPLETION OF THESE ITEMS
ASSISTS IN THE INFANT DEATH MATCH OF BIRTH CERTIFICATES WITH DEATH
CERTIFICATES OF INFANTS. IT ALSO PREVENTS THE NOTICE FOR BIRTH
NOTIFICATIONS AND IMMUNIZATIONS FROM BEING MAILED TO GRIEVING
PARENTS.


                  INFORMATION FOR MEDICAL AND HEALTH USE ONLY

The information for medical and health studies are separated from the identifying
information so that they can be excluded from certified copies of the certificate. They are
used for a wide range of research and medical purposes.

Information obtained for this portion of the birth certificate should come from the physician’s
prenatal record for the mother, labor and delivery records, neonatal unit records or other
hospital medical records.




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30-35. PARENT INFORMATION – if parent information is not known, enter Unknown
after item heading line

30. RACE (Specify the race/races to indicate what mother considers herself to be.
More than one race can be specified)

Check the race of the mother as obtained from the informant. Item 30 should be completed
for the mother on all certificates. Mark all entries that apply. Complete “other, specify” as
needed, e.g. Hispanic. If not known, enter Unknown after item heading line. Do not leave
this item blank.

THIS ITEM ALLOWS FOR MULTIPLE ENTRIES FOR “RACE” IN ORDER TO OBTAIN
MORE SPECIFIC INFORMATION. IT IS USED TO STUDY HEALTH CHARACTERISTICS
FOR RACIAL GROUPS (CHILDBEARING TRENDS, INFANT MORTALITY, BIRTH
WEIGHT, ETC.). RACE IS AN IMPORTANT VARIABLE IN PLANNING FOR AND
EVALUATING THE EFFECTIVENESS OF HEALTH PROGRAMS, AND IT IS ALSO USED
IN PREPARING POPULATION ESTIMATES.

31. OF HISPANIC OR HAITIAN ORIGIN? (Specify if mother is of Hispanic or Haitian
Origin)

Check only one. Specify “Yes” or "No." If "Yes" is checked, indicate the appropriate choice`
as obtained from the parent(s) or other informant. Item 31 should be marked for the mother
on all certificates. The entry in this item should reflect the response of the informant. If
there is more than one, Check Other Hispanic (Specify) and enter
Puerto Rican/Cuban or Mexican/Guatemalan, etc. If not known, enter Unknown after item
heading line. Do not leave this item blank.

For the purposes of this item, "Hispanic" refers to those people whose origins are from
Spain, Mexico, or the Spanish-speaking countries of Central or South America. Origin can
be viewed as the ancestry, nationality, lineage, or country in which the person or his or her
ancestors were born before their arrival in the United States.

There is no set rule as to how many generations are to be taken into account in determining
Hispanic or Haitian origin. A person may report Hispanic or Haitian origin based on the
country of origin of a parent, grandparent, or some far-removed ancestor. The response
should reflect what the person considers himself or herself to be and is not based on
percentages of ancestry. Although the prompts include the major Hispanic groups of
Cuban, Mexican, and Puerto Rican, other Hispanic groups should also be identified in the
space provided.

This item is not a part of the Race item. A person of Hispanic origin may be of any race.
Each question, Race and Hispanic origin, should be asked independently.

HISPANICS COMPRISE THE LARGEST ETHNIC MINORITY IN THIS COUNTRY, AND IN
FLORIDA, HAITIANS ALSO COMPRISE A LARGE MINORITY. THIS ITEM PROVIDES
DATA TO MEASURE DIFFERENCES IN FERTILITY AND PREGNANCY OUTCOME AS
WELL AS VARIATIONS IN HEALTH CARE FOR PEOPLE OF HISPANIC, HAITIAN, AND
NON-HISPANIC OR HAITIAN ORIGIN. WITHOUT COLLECTION OF DATA ON PERSONS
OF THESE GROUPS, IT IS IMPOSSIBLE TO OBTAIN VALID DEMOGRAPHIC AND
HEALTH INFORMATION ON THIS IMPORTANT GROUP OF AMERICANS.


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32. EDUCATION (Specify the mother’s highest degree or level of school completed at
time of delivery)

Mark the appropriate line that reflects the level of education of the mother. Count formal
schooling. Do not include beauty, barber, trade, business, technical, or other special
schools in this entry. If parent is from another country and has completed secondary
education, check “high school diploma or GED.” If not known, enter Unknown after item
heading line.

EDUCATION IS CLOSELY RELATED TO FERTILITY, HEALTH PRACTICES, AND BIRTH
OUTCOME. IT IS ALSO USED AS AN INDICATOR OF SOCIOECONOMIC STATUS.

33. RACE (Specify the race/races to indicate what father considers himself to be.
More than one race can be specified)

If a father is listed on the certificate, check the race of the father as obtained from the
informant. Mark all entries that apply. Complete “other, specify” as needed, e.g. Hispanic.
If father is not known, enter Unknown after item heading line. Do not leave this item blank.

THIS ITEM ALLOWS FOR MULTIPLE ENTRIES FOR “RACE” IN ORDER TO OBTAIN
MORE SPECIFIC INFORMATION. IT IS USED TO STUDY HEALTH CHARACTERISTICS
FOR RACIAL GROUPS (CHILDBEARING TRENDS, INFANT MORTALITY, BIRTH
WEIGHT, ETC.). RACE IS AN IMPORTANT VARIABLE IN PLANNING FOR AND
EVALUATING THE EFFECTIVENESS OF HEALTH PROGRAMS, AND IT IS ALSO USED
IN PREPARING POPULATION ESTIMATES.

34. OF HISPANIC OR HAITIAN ORIGIN? (Specify if father is of Hispanic or Haitian
Origin)

If a father is listed on the certificate, check only one. Specify “Yes” or "No." If "Yes" is
checked, indicate the appropriate choice` as obtained from the parent(s) or other informant.
The entry in this item should reflect the response of the informant. If there is more than one,
check Other Hispanic (Specify) and enter Puerto Rican/Cuban or Mexican/Guatemalan, etc.
If father is not known, enter Unknown after item heading line. Do not leave this item blank.

For the purposes of this item, "Hispanic" refers to those people whose origins are from
Spain, Mexico, or the Spanish-speaking countries of Central or South America. Origin can
be viewed as the ancestry, nationality, lineage, or country in which the person or his or her
ancestors were born before their arrival in the United States.

There is no set rule as to how many generations are to be taken into account in determining
Hispanic or Haitian origin. A person may report Hispanic or Haitian origin based on the
country of origin of a parent, grandparent, or some far-removed ancestor. The response
should reflect what the person considers himself or herself to be and is not based on
percentages of ancestry. Although the prompts include the major Hispanic groups of
Cuban, Mexican, and Puerto Rican, other Hispanic groups should also be identified in the
space provided.

This item is not a part of the Race item. A person of Hispanic origin may be of any race.
Each question, Race and Hispanic origin, should be asked independently.


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HISPANICS COMPRISE THE LARGEST ETHNIC MINORITY IN THIS COUNTRY, AND IN
FLORIDA, HAITIANS ALSO COMPRISE A LARGE MINORITY. THIS ITEM PROVIDES
DATA TO MEASURE DIFFERENCES IN FERTILITY AND PREGNANCY OUTCOME AS
WELL AS VARIATIONS IN HEALTH CARE FOR PEOPLE OF HISPANIC, HAITIAN, AND
NON-HISPANIC OR HAITIAN ORIGIN. WITHOUT COLLECTION OF DATA ON PERSONS
OF THESE GROUPS, IT IS IMPOSSIBLE TO OBTAIN VALID DEMOGRAPHIC AND
HEALTH INFORMATION ON THIS IMPORTANT GROUP OF AMERICANS.

35. EDUCATION (Specify the father’s highest degree or level of school completed at
time of delivery)

If a father is listed on the certificate, check the appropriate line that reflects the level of
education of father. Count formal schooling. Do not include beauty, barber, trade,
business, technical, or other special schools in this entry. If father is from another country
and has completed secondary education, check “high school diploma or GED.”

EDUCATION IS CLOSELY RELATED TO FERTILITY, HEALTH PRACTICES, AND BIRTH
OUTCOME. IT IS ALSO USED AS AN INDICATOR OF SOCIOECONOMIC STATUS.

36a-42e. PREGNANCY HISTORY

36a. PRENATAL CARE RECEIVED? (If no, skip to # 37)

Check “Yes” or “No,” as appropriate. If no entry, leave items 36b-d blank.

36b. DATE OF FIRST PRENATAL VISIT (Month, Day, Year)

Enter the date of the first prenatal visit after becoming pregnant, when the mother first
received care from a physician or other health professional or attended a prenatal clinic, as
listed in the health care practitioner’s record.

If the exact day is unknown, but the month and year are known, obtain an estimate of the
day from the mother or her physician. If an estimate of the date cannot be obtained, enter
only the month and year. This date cannot be after the child’s date of birth.

THIS INFORMATION, IN CONJUNCTION WITH THE DATE OF LAST NORMAL MENSES,
PROVIDES DATA FOR THE MONTH THAT PRENATAL CARE BEGAN. THIS ITEM IS
NEEDED AS THE BASIS FOR MEASURES OF HOW SOON WOMEN INITIATE
PRENATAL CARE AND FOR MEASURES OF THE APPROPRIATE UTILIZATION OF
SERVICES.




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36c. DATE OF LAST PRENATAL VISIT (Month, Day, Year)

Enter the date of the mother’s last prenatal visit before delivery as recorded in the health
care practitioner’s record. If the exact day is unknown, but the month and year are known,
obtain an estimate of the day from the mother or her physician. If an estimate of the date
cannot be obtained, enter only the month and year.

THIS ITEM WILL ENSURE THAT ALL PRENATAL VISITS ARE COUNTED.

36d. PRENATAL VISITS

Enter the number of visits made for medical supervision from a physician or other health
care provider during the pregnancy.

THIS INFORMATION IS USED TO DETERMINE THE RELATIONSHIP OF PRENATAL
CARE TO THE HEALTH OF THE CHILD AT BIRTH.

37. DATE LAST NORMAL MENSES BEGAN (Month, Day, Year)

Enter the exact date (month, day, and year), as obtained from the physician or hospital
record, of the beginning of the mother's last normal menstrual period. If the information is
unavailable from these sources, obtain it from the mother.

It is preferred that a written date entry, rather than numerical, be made.

If the exact day is unknown, but the month and year are known, obtain an estimate of the
day from the mother or her physician. If an estimate of the date cannot be obtained, enter
only the month and year.

If mother never has had a menses, enter “Never had menses.”

Enter "Unknown" if the date cannot be determined.

THIS ITEM, IN CONJUNCTION WITH THE DATE OF BIRTH, IS USED TO DETERMINE
THE LENGTH OF GESTATION, WHICH IS RELATED TO INFANT MORBIDITY AND
MORTALITY. LENGTH OF GESTATION IS ASSOCIATED WITH BIRTH WEIGHT IN
DETERMINING THE MATURITY OF THE CHILD AT BIRTH AND THUS IS IMPORTANT IN
MEDICAL RESEARCH.

38. MOTHER’S HEIGHT

Enter mother’s height in feet and inches. Ideally, height should be measured without shoes.
Verify entries of 2-3 feet and 7-8 feet; put notation on back of record in upper right margin.
Do not enter inches only; for 66 inches, enter 5 ft. 6 in. There should be no fractions or
decimals, only whole number feet and inches. If 5 ft. 6 ½ in., enter 5 ft. 6 in; if 5 ft. ¼ in.,
enter 5 ft. 0 in. If no inches, enter 5 ft. 0 in.

MOTHER’S HEIGHT, IN CONJUNCTION WITH PRE-PREGNANCY AND AT-DELIVERY
WEIGHT, CORRELATES WITH POSSIBLE OBESITY AND ITS EFFECT ON THE HEALTH
OF THE MOTHER AND A HEALTHY OUTCOME FOR THE CHILD.



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39a-b. MOTHER’S WEIGHT (in pounds)

Enter mother’s weight at first prenatal visit and at delivery. Ideally, weight should be taken
without shoes. Enter “Unk” if the weight cannot be determined or is unknown for either item.
There should be no fractions or decimals, only a whole number. If 140 ½ lbs, enter 140 lbs;
if 150.3 lbs, enter 150 lbs.

MOTHER’S WEIGHT, PRE-PREGNANCY AND AT-DELIVERY, IN CONJUNCTION WITH
MOTHER’S HEIGHT, CORRELATES WITH POSSIBLE OBESITY AND ITS EFFECT ON
THE HEALTH OF THE MOTHER AND A HEALTHY OUTCOME FOR THE CHILD.

40. TOBACCO USE DURING PREGNANCY

Check "Yes" for tobacco use if the mother smoked tobacco at any time during the
pregnancy. Specify the average number of cigarettes the mother smoked per day during
her pregnancy. If the mother smoked but quit during the pregnancy, mark “Yes, but quit”;
specify the average number of cigarettes the mother smoked per day before she quit. If, on
the average, she smoked less than one cigarette per day, enter "Less than 1" (<1).

Check "No" if the mother did not smoke during the entire pregnancy. Do not make any entry
on the line requesting the average number of cigarettes per day.

This information should be taken from the physician’s prenatal record for the mother.

41. ALCOHOL USE DURING PREGNANCY

Check "Yes" for alcohol use if the mother consumed alcoholic beverages at any time during
her pregnancy. Check "No" if the mother did not consume any alcoholic beverages during
her entire pregnancy.

This information should be taken from the physician’s prenatal record for the mother.

SMOKING AND DRINKING DURING PREGNANCY MAY HAVE AN ADVERSE IMPACT
ON PREGNANCY OUTCOME. THIS INFORMATION IS USED TO EVALUATE THE
RELATIONSHIP BETWEEN CERTAIN LIFESTYLE FACTORS AND PREGNANCY
OUTCOME AND TO DETERMINE AT WHAT LEVELS THESE FACTORS CLEARLY
BEGIN TO AFFECT PREGNANCY OUTCOME.

42a-e. PREVIOUS LIVE BIRTHS (Do not include this child)
The birth registrar should be sure the information entered for these items agree with the
information provided in items 51a-b having to do with multiple births.




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42a. Number Now Living

Enter the number of prior children born alive to this mother who are still living at the time of
this birth. Do not include this child or children by adoption. If this is the first pregnancy for
the mother, enter “0.” If not known, enter “Unknown” or “Unk.”

42b. Number Now Dead

Enter the number of prior children born alive to this mother who are no longer living at the
time of this birth. Do not include this birth or any children by adoption. If this is the first
pregnancy for the mother, enter “0.” If not known, enter “Unknown” “Unk.”

42c. DATE OF LAST LIVE BIRTH (Month, Year)

Enter the date of birth (month and year) of the last live-born child of the mother. It is
preferred that the literal name of the month, in abbreviated form, be used.

If this certificate is for the second birth of a twin set, enter the date of birth for the first baby
of the set, if it was born alive. Similarly, for triplets or multiple births, enter the date of birth
of the previous live birth of the set. If all previously delivered members of a multiple set
were fetal deaths, enter the date of the mother's last delivery that resulted in a live birth.

Enter "None" if mother has not had a previous live birth. If not known, enter “Unk.”

42d. OTHER PREGNANCY OUTCOMES (spontaneous, induced, ectopic)

Include each recognized loss of a product of conception such as miscarriage, fetal death,
and abortion (spontaneous and induced). Enter "0" if this is the first pregnancy for this
mother or if all previous pregnancies resulted in live-born infants. If not known, enter “Unk.”

If there is a twin pregnancy, and one twin dies prior to delivery and the second twin is
carried to term, this item should include the twin who died. Do not leave this item blank.

42e. DATE OF LAST OTHER OUTCOME (Month, Year)

Enter the date (month and year) of the last other outcome of pregnancy that was not a live
birth regardless of the length of gestation. It is preferred that the literal name of the month,
in abbreviated form, be used. If the mother has never had a termination, enter "None." If
not known, enter “Unk.” Do not leave this item blank.

If this certificate is for the second birth of a twin set and the first was a fetal death, enter the
date of delivery of that fetal death. Similarly, for other multiple births, if any previous
member of the set was a fetal death, enter the date of delivery of that fetal death. If all
previously born members of a multiple set were live births, enter the date of the mother's last
delivery that resulted in a fetal death.

THESE ITEMS ARE USED TO DETERMINE LIVE BIRTH ORDER AND TOTAL BIRTH
ORDER THAT ARE IMPORTANT IN STUDYING TRENDS IN CHILDBEARING AND CHILD
SPACING. THEY ARE ALSO USEFUL IN STUDYING HEALTH PROBLEMS (e.g.,
HEALTH PROBLEMS ASSOCIATED WITH FIRST BIRTHS TO OLDER MOTHERS,
RELATIONSHIP OF INFANT MORTALITY TO BIRTH ORDER, ETC.).


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THE DATES OF LAST LIVE BIRTH AND OTHER OUTCOMES ARE USED TO COMPUTE
THE INTERVALS BETWEEN LIVE BIRTHS AND FETAL DEATHS AND BETWEEN
PREGNANCIES IN STUDYING CHILD SPACING. THEY ARE ALSO IMPORTANT IN
DETERMINING WHETHER THERE ARE HEALTH PROBLEMS ASSOCIATED WITH
CLOSE SPACING OR WITH THE OUTCOME OF THE PREVIOUS PREGNANCY
(WHETHER OR NOT IT WAS A LIVE BIRTH).

43-49. MEDICAL AND HEALTH INFORMATION

The following medical and health items are formatted into check-off lines. It has been
demonstrated that this format produces higher quality and more complete information than
open-ended items. If information is unknown or unavailable, do not mark any item; enter
“Unknown” after the item heading line.

Please review each item listed and carefully check the appropriate line(s). The mark should
not overlap more than one line. If an item is not listed, mark, “Other (specify) and make the
appropriate entry.

The information for these items should come from the mother’s prenatal record and her
medical record.

43. HISTORY FACTORS FOR THIS PREGNANCY (Check all that apply)

Mark all that apply. Check each of the medical history factors that the mother experienced
during this pregnancy. If the mother experienced medical history factor(s) not identified in
the list, check "Other" and enter the history factor on the line provided. Medical history
factors should be identified from the hospital or physician record.

For diabetes, designate whether it was Prepregnancy or Gestational. Do not check both.
For Hypertension, designate whether it was Prepregnancy, Gestational or Eclampsia; make
only one entry. If there were no medical history factors, check "None." Do not leave this
item blank.

THIS INFORMATION ALLOWS FOR THE IDENTIFICATION OF SPECIFIC MATERNAL
CONDITIONS THAT ARE OFTEN PREDICTIVE OF POOR MATERNAL AND INFANT
OUTCOME. IT CAN BE USED FOR PLANNING INTERVENTION AND PREVENTION
STRATEGIES.

44. INFECTIONS PRESENT AND/OR TREATED DURING THIS PREGNANCY (Check all
that apply)

Mark all that apply.

ALL OF THE LISTED INFECTIONS ARE KNOWN TO CAUSE FETAL AND/OR
SUBSEQUENT NEONATAL INFECTION AND HAVE SIGNIFICANT PUBLIC HEALTH
IMPLICATIONS.

45. OBSTETRIC PROCEDURES (Check all that apply)




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Mark all that apply. If External cephalic, it can’t be both successful and failed – check only
one.

OBSTETRIC PROCEDURES DETECT POSSIBLE PROBLEMS WITH THE FETUS THAT,
WHEN DETECTED, CAN BE CORRECTED OR TREATED PRIOR TO OR IMMEDIATELY
AFTER BIRTH AND CAN POSSIBLY HELP TO PREVENT PREMATURE DELIVERY.

46. ONSET OF LABOR (Check all that apply)

Mark all that apply. Precipitous and Prolonged cannot both be checked, it is either one or
the other.

MONITORING OF MEDICAL INDUCTION OF LABOR IS NEEDED TO ASSESS ITS
EFFECT ON CAESAREAN DELIVERY RATES AND PERINATAL AND MATERNAL
OUTCOMES. NON-VERTEX PRESENTATION IS A RISK FACTOR THAT MAY BE AN
INDICATION FOR CAESAREAN DELIVERY.

47. CHARACTERISTICS OF LABOR AND DELIVERY (Check all that apply)

Mark all that apply.

INFORMATION ON STEROIDS FOR FETAL LUNG MATURATION SUPPORTS THEIR
USE IN THREATENED PRETERM DELIVERY PRIOR TO 32 WEEKS GESTATION TO
REDUCE RISK FOR MULTIPLE ADVERSE NEONATAL OUTCOMES.

CLINICAL CHORIOAMNIONITIS INFORMATION IS NEEDED TO CORRELATE WITH
ANTIBIOTIC USE AND PRETERM DELIVERY DUE TO AN INCREASE IN INFORMATION
THAT SUGGESTS INFECTION AS A MAJOR PRECIPITATING FACTOR FOR PRETERM
LABOR AND CAUSATION OF PALSY.

48. METHOD OF DELIVERY

Complete all items A through D. This information should be obtained from the mother's
medical chart or the physician. If the information is unknown, enter Unknown after the
appropriate item.

Information should be consistent e.g.:
       Item A - if delivery with forceps was attempted and successful, item A must
       indicate No; item D should have Vaginal/Forceps checked;
       Item B - if vacuum delivery was attempted and successful, item B must indicate No;
       item D should have Vaginal/Vacuum checked;
       Item C - Vertex is the same as Cephalic;
       Item D – If Cesarean delivery, answer Yes or No to Was a trial of labor attempted

THIS INFORMATION IS USED TO RELATE METHOD OF DELIVERY WITH BIRTH
OUTCOME, TO MONITOR CHANGING TRENDS IN OBSTETRIC PRACTICE, AND TO
DETERMINE WHICH GROUPS OF WOMEN ARE MOST LIKELY TO HAVE CESAREAN
DELIVERY.




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THE METHOD OF DELIVERY IS RELEVANT TO THE HEALTH OF MOTHERS,
ESPECIALLY IF IT IS BY CESAREAN SECTION. INFORMATION FROM THIS ITEM CAN
BE USED TO MONITOR DELIVERY TRENDS ACROSS THE UNITED STATES.

49. MATERNAL MORBIDITY (complications associated with labor and delivery)

Mark all that apply.

LABOR/DELIVERY COMPLICATIONS MAY AFFECT THE MOTHER’S ABILITY TO
BECOME PREGNANT IN THE FUTURE.

50-57. NEWBORN

50. CLINICAL ESTIMATE OF GESTATION

Enter the number of completed weeks as estimated by the attendant. Do not compute this
information from the date last normal menses began and date of birth. If the attendant has
not done a clinical estimate of gestation, enter "Not Done." Do not leave this item blank.

THIS ITEM PROVIDES INFORMATION ON GESTATIONAL AGE WHEN THE ITEM ON
DATE LAST NORMAL MENSES BEGAN CONTAINS INVALID OR MISSING
INFORMATION. FOR A RECORD WITH A PLAUSIBLE DATE LAST NORMAL MENSES
BEGAN, IT PROVIDES A CROSSCHECK WITH LENGTH OF GESTATION BASED ON
ULTRASOUND OR OTHER TECHNIQUES.

51a-b. PLURALITY (Birth Order)

When a multiple birth occurs, prepare and register a separate certificate for each child or
fetus. Register certificates relating to the same multiple birth set at the same time, unless
doing so will result in late filing. If records not filed at the same time or one of the deliveries
results in a fetal death, put a note on the back in the upper right margin.

In incidents where there is a twin pregnancy, and one twin dies prior to delivery and the
second twin is carried to term, the certificate should include the deceased twin in the
number of other outcomes (42d), and the date of last outcome (42e). Plurality (51a) should
indicate “twin.” Conjoined twins must have a birth record filed for each twin.

If this is a multiple birth, the birth registrar should verify if the pregnancy was a result of
infertility treatment. If the answer is “yes,” item 43, in “History Factors,” should be checked.

51a. PLURALITY (Single, twin, etc.)

Specify the birth as single, twin, triplet, quadruplet, etc.

51b. IF NOT SINGLE BIRTH (Born first, second, etc.)

Specify the order in which the child being recorded was born-first, second, etc. If this is a
single birth, leave the item blank. For multiple births still in the womb and for multiple births
that include a fetal death under 20 weeks gestation, make a note on the back of the record
in the upper right margin, indicating which multiple.



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THESE ITEMS ARE RELATED TO OTHER ITEMS ON THE CERTIFICATE THAT HAVE
BEEN SHOWN TO HAVE HEALTH IMPLICATIONS, ESPECIALLY BIRTH WEIGHT. THE
OCCURRENCE OF PLURAL BIRTHS IS RELATED TO THE AGE OF THE MOTHER AND
BIRTH ORDER OF THE CHILD.

52. IS INFANT BEING BREASTFED?

Mark “Yes” or “No.” If infant has died, Mark “No.” This answer should be based on the
mother’s intent while still in the hospital.

53. APGAR SCORES

Enter the Apgar score taken at five minutes, as assigned by the delivery room personnel. If
the five-minute Apgar score is less than six, the Apgar should be taken again at 10 minutes
and the 10 minute score should also be entered. If the Apgar is not done at ten minutes, put
a note on the back of the record, in the upper right margin, stating, “ten minute not done.”

If Apgar is not taken at five minutes, enter “not done.” If Apgar scores are unknown, enter
UNK in both the five and 10 minute items.

THE FIVE-MINUTE APGAR SCORE IS A VALID PREDICTOR OF THE INFANT’S
HEALTH. IF THE APGAR SCORE IS LESS THAN SIX AT FIVE MINUTES, THE APGAR
SHOULD BE TAKEN AGAIN AT 10 MINUTES. IF IT IS NECESSARY TO TAKE A TEN
MINUTE APGAR SCORE IT WILL MOST LIKELY BE PERFORMED IN THE NEONATAL
INTENSIVE CARE UNIT.

THE APGAR SCORE IS REGARDED AS A RELIABLE SUMMARY FOR EVALUATING
THE HEALTH OF THE INFANT AND IS VALUABLE IN RESEARCH AND STATISTICAL
ANALYSIS WHEN RELATED TO OTHER ITEMS ON THE CERTIFICATE.

54. ABNORMAL CONDITIONS (Check all that apply)

Check each abnormal condition associated with the newborn infant. If more than one
abnormal condition exists, check each condition. If an abnormal condition is present that is
not identified in the list, check "Other" and specify the condition on the line provided. This
information should be obtained from the mother's and infant's physicians or the medical
records (obstetric and pediatric). If Assisted Ventilation, check only one. Do not leave
this item blank.

INFORMATION ON ABNORMAL CONDITIONS OF THE NEWBORN HELPS MEASURE
THE EXTENT INFANTS EXPERIENCE MEDICAL PROBLEMS AND CAN BE USED TO
PLAN FOR THEIR HEALTH CARE NEEDS. THIS ITEM ALSO PROVIDES A SOURCE OF
INFORMATION ON ABNORMAL OUTCOME IN ADDITION TO CONGENITAL ANOMALY
OR INFANT DEATH. THESE DATA ALLOW RESEARCHERS TO ESTIMATE THE
NUMBER OF HIGH-RISK INFANTS WHO MAY BENEFIT FROM SPECIAL MEDICAL
SERVICES.

55. CONGENITAL ANOMALIES (Check all that apply)

Check each anomaly of the child. Do not include birth injuries. The anomalies listed should
be only those that are obvious at birth. The checklist of anomalies is grouped according to


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major body systems. If an anomaly is present that is not identified in the list, check "Other"
and specify the anomaly on the line provided. If Cleft Palate is indicated, check only one;
do not check both Cleft Lip with or without Cleft Palate and Cleft Palate alone.

If there are no congenital anomalies of the child, check "None."

This information should be obtained from the mother's and infant's physicians or the medical
records (obstetric and pediatric). Do not leave this item blank.

INFORMATION ON CONGENITAL ANOMALIES IS USED TO IDENTIFY HEALTH
PROBLEMS THAT REQUIRE MEDICAL CARE AND MONITOR THE INCIDENCE OF THE
STATED CONDITIONS. IT IS ALSO USED TO STUDY UNUSUAL CLUSTERS OF
SELECTED ANOMALIES, TO TRACK TRENDS AMONG DIFFERENT SEGMENTS OF
THE POPULATION, AND TO RELATE THE PREVALENCE OF ANOMALIES TO OTHER
CHARACTERISTICS OF THE MOTHER, INFANT, AND THE ENVIRONMENT.




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                                      CHAPTER 4 – REGISTRATION OF DEATHS



                      CHAPTER 4 – REGISTRATION OF DEATHS
GENERAL

The registration of the death certificate is the responsibility of the funeral director/direct
disposer who first assumes custody of a dead body. There is no mechanism for placing a
death record on file except through the funeral director or person acting as such. In the
event death occurs without medical attendance, is known or suspected to be an accident,
homicide, or suicide, the signature of the medical examiner is required on the death
certificate. For natural deaths, the attending physician must sign the death record.

The funeral director must deliver a completed death certificate to the registrar of the county
where death occurred within five calendar days after death or before final disposition or
shipment of the decedent out of state. He/she must also obtain a burial-transit permit within
five days or before final disposition of the decedent. See Chapter 6, The Burial Transit
Permit, for information on the burial transit permit.

In cases where there is an attending physician, the following persons, when duly licensed
(pursuant to chapters 458, 459, and 460, F.S.) and registered in our state, are entitled to
complete and sign the medical certification of the death certificate: medical doctors,
osteopaths, and chiropractors. Where death occurs without medical attendance, the
medical certification on the death certificate must be signed by the medical examiner.
(Refer to s. 382.011 (1), F. S.)

CERTIFICATE TO BE FILED

All deaths in the state must be registered in accordance with s. 382.008, F.S. The death
certificate shall be registered with the local registrar of the county in which the death
occurred within five calendar days after such death or discovery of death. If the place of
death is unknown, the death certificate shall be registered in the county in which the death is
discovered. If death occurs on a moving conveyance, the death certificate shall be
registered in the county in which the dead body is first removed from such conveyance.

DEATH RECORD - FORM

The original certificate of death shall be on a form approved by the state registrar. The
death certificate shall contain the information required by the department, plus those items
declared necessary for legal, social, and health purposes. The personal and statistical
particulars on the form shall be obtained from the best source available.

RESPONSIBILITIES OF LOCAL REGISTRARS IN DEATH REGISTRATION

The local registrar reviews all incoming death certificates to determine acceptability and
compliance with state law. He/she must take all necessary action to insure compliance,
document and report to the state registrar those cases requiring further action. Particular
attention is exercised in screening death certificates to determine if any fall within the
jurisdiction of the medical examiner and should, therefore, have been reviewed and signed
by him/her. Should the funeral director or subregistrar fail to notify the medical examiner if
any such cases are discovered, the local registrar must make the proper notification to the
medical examiner.



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Local registrars may issue burial-transit permits for those deaths that occur in their county
only. The permit is used for tracking to make sure the death certificate is filed on time. For
all records not received within five days, an informal investigation will be initiated by the local
registrar and the person or persons responsible for the delay are required to report the
reasons for the delay. The state registrar must be notified in writing regarding persons who
repeatedly violate this section of the vital statistics law.

FUNERAL DIRECTOR/DIRECT DISPOSER'S RESPONSIBILITY

The funeral director/direct disposer who first assumes custody of the decedent must obtain
the required personal and statistical particulars and present the death certificate to the
attending physician, or to the medical examiner when applicable, for signature and medical
certification of the cause of death. He/she must place on the record the facts relative to
place of burial or other disposition, sign the record, list his or her address, and present the
completed record to the local registrar or a subregistrar.

The funeral director/direct disposer must deliver a burial-transit permit to the person in
charge of the place of final disposition before interring or otherwise disposing of the
decedent or attach the permit to the shipping container when the decedent is transported
out of state. To obtain this permit, he must complete and sign the application for burial-
transit permit and present it to the subregistrar or deputy registrar. If a completed death
certificate will accompany the application, check box 5a, under section A of the application
for burial transit permit. In those cases where a certificate of death does not accompany the
permit, check box 5b or 5c, as appropriate, of the burial-transit permit application.

BURIAL WITHOUT FUNERAL DIRECTOR

If no licensed funeral director/direct disposer buries or otherwise disposes of the decedent,
responsibility for preparing and registering the required death certificate as stated above,
and obtaining the burial-transit permit rests upon the person in charge of such burial or
disposition.

If the hospital makes final disposition (in cases of infant or fetal death), they must prepare
and register the death certificate, obtain the permit as stated above and notify the medical
examiner as provided in s. 406.11 (1) (c), F.S.; and follow all laws and rules regarding
disposition as provided in ch. 470, F.S.

If the decedent is to be used in medical study and/or cremated at a later date, the hospital
must notify the medical examiner as noted above. In preparing the record, “Other Specify”
should be checked in item 26a and “Hospital Disposition” entered. Items 24-25a-b should
show the hospital name and location. The chief of staff, head of pathology, or other
appropriate hospital official will act as funeral director and should sign in item 27b and return
the permit to the local registrar after his or her endorsement showing disposition.




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APPOINTMENT OF SUBREGISTRARS

The state registrar may appoint one or more subregistrars for each licensed funeral home or
registered direct disposal establishment based upon the request of the director of the
establishment and the recommendation of the county local registrar. In regards to vital
statistics issues, these subregistrars are subject to the supervision and control of the state
registrar and subject to the same penalties for neglect of duty, as are all deputy registrars.
Subregistrars may be terminated from such positions by the state registrar as the result of
their neglect or failure to properly perform the duties of the office.

A licensed funeral director or registered direct disposer may be appointed as a subregistrar
as long as he/she does not issue burial-transit permits to himself/herself. Each subregistrar
must:
    1. Be a notary public commissioned in the state of Florida;
    2. Attend a subregistrar training class;
    3. Sign an acceptance form.

The subregistrar's commission authorizes him/her to issue burial-transit permits for deaths
that occur in this state. When a subregistrar terminates association with an establishment,
the subregistrar's commission is canceled. It is the responsibility of the person in charge of
the establishment to notify the state office through the local registrar's office. The
commission should then be returned to the state office.

If an establishment has a name change, it is the responsibility of the subregistrar to notify
the local vital statistics office. A new application must be completed with the new
establishment name.

If a former subregistrar becomes associated with another establishment, he/she can again
be commissioned as a subregistrar at the new location by following the regular application
procedure.

RESPONSIBILITIES OF SUBREGISTRARS

Upon receipt of a properly completed burial-transit permit application and accompanying
death certificate, the subregistrar is authorized to process and issue a burial-transit permit.
Funeral establishment subregistrars are an extension of the local registrar and are to adhere
to legal compliance and cooperate fully with local registrars and their staff.

Subregistrars should review all death certificates to prevent errors and/or omissions and to
accept or reject records accordingly. Prior to signing the death certificate in item 37, the
subregistrar should review the record after the certifier has completed the cause of death
information. It is their responsibility to determine that the medical examiner reviews and
signs all death certificates that fall under his/her jurisdiction. The medical examiner and
county local registrar must be notified immediately when there is a doubt as to whether a
situation qualifies as a medical examiner’s case.

Burial-transit permits are made in triplicate and must be numbered in consecutive order,
prefaced by year and the funeral establishment number or direct disposal establishment
registration number. For example, the first permit issued at a funeral establishment with
license number 250 would be 2004-250-1. Upon numbering and completion of the permit,
the original (white) accompanies the body, the first copy (yellow) is retained by the funeral


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establishment, and the second copy (pink) is to be delivered or mailed within 24 hours after
issuance to the county local registrar in the county health department of the county where
death occurred.

A subregistrar may not be commissioned at more than one establishment; however, if they
work at more than one establishment or issue to an establishment other than his/her own,
the permit number can be the next sequential number of that second establishment.
See Assigning the Burial Transit Permit Number, Chapter 6, Preparing the Burial-Transit
Permit.

The subregistrar will notify the local registrar of any death that has not been registered
within 5 days. Subregistrars are not authorized to issue certified copies or any copy that
may appear to be a certified copy of a death certificate.

NOTE: When processing burial-transit permits, keep in mind that a funeral director/direct
disposer cannot issue himself/herself a burial-transit permit.

BURIAL-TRANSIT PERMIT REQUIRED (S. 382.006 F.S.)

The funeral director/direct disposer who first assumes custody of a dead body must obtain a
burial-transit permit prior to final disposition of the decedent or removal of the body from the
state, and in all cases within five calendar days after the death occurred or was discovered.
To obtain this permit, he must complete and sign the application for burial-transit permit
(section A) and present it to either the local registrar of the county in which the death
occurred or to a subregistrar (funeral establishment) within five calendar days of death. The
name listed on the permit should be the legal name of the decedent.

A funeral director/direct disposer cannot issue a burial-transit permit to himself. The permit
must be mailed or delivered to the local registrar within 24 hours after issuance.

Subregistrars within funeral establishments can issue a burial-transit permit for a death that
occurs in any county. However, local registrars can issue these permits only for deaths that
occur within their county.

For detailed information on the burial-transit permit and its completion, refer to Chapter 6,
Preparing the Burial-Transit Permit.

BURIAL WITHOUT PERMIT

If final disposition has been made of the decedent before a burial-transit permit has been
issued, subsequent issuance will not remedy this violation of the vital statistics laws, nor
does its issuance serve any other useful purpose. These cases should be documented by
the local registrar and reported to the state registrar.




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DISINTERMENT/REINTERMENT PERMIT

The Disinterment/reinterment permit was repealed effective July 1, 1997. All other statutory
requirements for disinterring human remains are still in place. The repeal of the
disinterment/reinterment permit is the only thing that changed.

It is suggested that the funeral director type on funeral home letterhead stationery a
statement indicating that the form no longer exists and send the letter, accompanied by a
certified copy of the death certificate, along with the remains. The funeral director cannot
complete another burial transit permit for this purpose – remember, the BTP is for the “newly
dead” and it’s only one per customer.

PHYSICIAN'S RESPONSIBILITY IN DEATH REGISTRATION

The primary responsibility of the physician in death registration is:
   1. To complete the medical certification section of the death certificate;
   2. The medical certification section of the record must be completed, signed and made
       available to the funeral director/direct disposer within 72 hours after receipt;
   3. The physician is deemed responsible for knowledge of state statutes and the
       physician handbook regarding medical certification of causes of death.

When death occurs without medical attendance or when death is due to or with mention of
trauma, whether from accident, homicide or suicide, the physician should report the case to
the medical examiner.

When inquiry is required by the medical examiner, within 72 hours after taking charge of the
case:
   1. This official shall investigate the cause of death;
   2. Complete and sign the medical certification, or
   3. Complete a temporary record, indicating the cause of death is pending further
      investigation;
   4. Make application for the burial transit permit if there is no funeral home yet assigned
      to the case;
   5. He/she is also responsible for cooperating with the local and state registrars by
      replying promptly to medical queries concerning the medical certification of cause of
      death.

The medical certification shall be completed and signed by the physician in charge of the
decedent's care for the illness or condition that resulted in death, or by the physician in
attendance either at the time of death or immediately before or after. The certifier shall
specify the time when death occurred (24 hour clock); and he shall further state the cause(s)
of death, so as to show the course of events or sequence of causes resulting in the death,
stating:
    1. First the condition causing death (terminal);
    2. Followed by any contributing (secondary) cause(s);
    3. Then the underlying cause or initiating disease condition with the corresponding
         durations.

The cause of death should be the physician’s best medical opinion. Terms such as
“possible”, “probable”, etc. can be used when the certifier is not comfortable making an



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exact diagnosis. Death records can be amended at any time should additional information
become available.

Deaths that may be the result of either disease or violence shall be carefully defined; and if
trauma is mentioned, items 46 – 52b, the means of injury, shall be completed. Any
information that is not available to the certifier may be indicated as unknown or unavailable.
The Manner of Death, item 39, should be completed for all deaths, indicating whether it was
probably from natural causes, accident, suicide, homicide, or undetermined. If the manner
is stated to be other than natural or undetermined, a trauma must be reported in Part I or
Part II.

Subregistrars are also responsible for reviewing the record and the medical
certification to insure that traumatic deaths are reported to the medical examiner's
office.

WHO MAY SIGN MEDICAL CERTIFICATION

In cases where there is an attending physician, the following persons, when duly licensed
(pursuant to chapters 458, 459, and 460, F.S.) and registered in our state, are entitled to
complete and sign the medical certification of the death certificate: medical doctors,
osteopaths, and chiropractors. Where death occurs without medical attendance, the
medical certification on the death certificate must be signed by the medical examiner.
(Refer to s. 382.011 (1), F. S.). Nurse practitioners (ARNP) and physicians’ assistants (PA)
are not authorized under statute to certify cause of death.

PROBLEM GETTING PHYSICIAN TO SIGN RECORD

The physician in charge of the patient's care for the illness or condition that resulted in death
must complete the medical certification of the certificate of death within 72 hours after being
presented the death record by the funeral director.

Many times the physician is reluctant to sign a death record. He/she may feel they are not
completely sure of the actual cause of death or that it had been some time since they had
last seen the decedent. The statute and the death record itself (item 30) states that the
physician should determine cause of death to the best of their ability. The funeral director
must explain to the physician their responsibility and reference s. 382.008 (3) F.S. regarding
who the rightful certifier might be. The following are some suggestion for the funeral
director:

    1. Funeral director (FD), not funeral home staff, must speak to the physician to verify
       that he/she is willing to sign the DC. Law enforcement is not authorized to speak for
       the physician;
    2. Funeral director must speak to the physician personally, not their staff, and explain
       the statutory responsibility for certifying cause of death;
    3. Funeral director must provide written documentation that shows all their efforts to
       have the physician certify the death (Death Registration Delay Report);
    4. Why is the physician refusing to sign the DC according to the FD?
           a. Not physician’s patient;
           b. Covering physician;
           c. Hadn’t seen within 30 days;
           d. Not expected to die;


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            e. Should be ME case
    5. Where did the death occur?
            a. If at home:
                 1). Was there a police report? If so, the CDR should get a copy.
                 2). Was the ME notified?
                 3). If ME, as the district legal authority in these matters, has determined all
                     signs point to natural causes, the attending physician should certify the
                     death
            b. Did the death occur in a hospital or other facility?
                 1). Contact the Administrator or Risk Management office of the facility for
                     assistance;
                 2). Explain that this death was attended by at least one physician with
                     admitting privileges to this hospital and the appropriate physician should
                     sign the death certificate;
    6. Remind the physician: the cause of death should be the physician’s best medical
        opinion. Terms such as “possible”, “probable”, etc. can be used when the certifier is
        not comfortable making an exact diagnosis. Death records can be amended at any
        time should additional information become available.
    7. Keep the CDR informed of what is going on with the case;
    8. If above efforts are unsuccessful, the CDR can assist in getting the record filed;
    9. If the CDR is unsuccessful, the next step is for the Local Registrar to contact the
        certifier and apprise them of their responsibilities under the law;
    10. The medical examiner, in some districts, can be of assistance when trying to get a
        physician to understand their responsibility in certifying a death record. The CDR or
        Local Registrar may contact the ME for assistance.
    11. When all local efforts have failed to produce a death record, the state office must be
        contacted.

RESPONSIBILITY IN DEATHS WITHOUT MEDICAL ATTENDANCE

In s. 382.011(1), F. S., a death occurring more than 30 days after the decedent was last
treated by a physician, except where death was medically expected as certified by an
attending physician, should be reported to the medical examiner. It is presumed if a
physician is treating a patient and prescribing prescription(s) for a medical condition, this
physician is “attending”, even though the patient has not been seen by the physician in the
last 30 days. A physician covering for an absent colleague has access to the patient’s
medical records and can also be considered as attending. Pursuant to s. 406.11, F.S., the
medical examiner is responsible for the medical certification of cause of death in those
cases where the death is unattended by a physician.

Under that portion of the statute dealing with unattended deaths, the funeral director/direct
disposer or other person to whose knowledge the death may come, is required to notify the
medical examiner that a death occurring without medical attendance has come to his or her
attention. The funeral director/direct disposer may not dispose of the decedent prior to
registering the death certificate and/or obtaining a burial-transit permit.

The local registrar will take whatever steps deemed necessary to insure that a proper death
certificate is prepared and registered prior to authorizing a permit for disposition of the body.
If the medical examiner has not been notified, the registrar should refer the case to the
district medical examiner for investigation and certification.



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RESPONSIBILITY OF CEMETERY SEXTON

Sextons, owners or managers of cemeteries, crematoriums, mausoleums, or other premises
on which interments or other dispositions of decedents are made are required to have
presented to them a properly issued burial-transit permit before permitting disposition of the
body. Such person must endorse upon the burial-transit permit the date and method of
disposal, must affix his or her signature attesting to the facts of disposition, and return the
permit to the local registrar of the county where final disposition took place within ten days
from the date of disposition, as required by s. 382.007 F.S.

If no such person is available, the funeral director is to sign and date the permit and forward
it accordingly (s. 382.007, F.S.).

DEATH REGISTRATION DELAY REPORT (DH 1355)

Whenever a death certificate is not submitted to the local vital statistics office within the
statutory time of five calendar days (s. 382.008, F.S.), or after an extension of time has been
granted by a subregistrar or deputy registrar, a Death Registration Delay Report (DRD),
form DH 1355, must be submitted by the funeral director/direct disposer to the chief deputy
registrar of the county of death.

The DRD report is to be used when a physician or medical examiner has not completed the
cause of death on the death certificate within 72 hours (s. 382.008(3) or 382.011(2) F.S.).
All of the funeral director's attempts to obtain the death certificate from the physician/medical
examiner should be documented on this form.

The DRD report should only be used when a death certificate cannot be filed on time, due to
the physician or medical examiner delaying the certificate. It should not be used to justify
delays resulting from the use of the mail.

A death certificate should not be held up for filing if personal information is missing. Any
personal information not available at the time of filing should be entered as "unknown" or
"unobtainable" on the death certificate and the record must be submitted within the required
statutory time limit. The death certificate can be amended at a later date should the
personal information become available.

TEMPORARY (PENDING) DEATH RECORDS (s. 382.008 (4, 5) F.S.)

When the medical certification of the cause of death cannot be completed, pending autopsy
or medical examiner's report, within the allotted time, a temporary (pending) death certificate
is to be registered with the local registrar. A temporary death record is to be registered only
in cases where the cause of death is unknown, pending autopsy or official investigation, or
where the decedent has not been identified. Temporary records are to be forwarded to the
state office in the usual manner. The CDR should keep a log or record of all outstanding
temporary records and follow-up with the funeral director after 30 days to check on the
status.

A temporary death certificate is to be registered only in cases where the cause of death is
unknown, pending autopsy, official report or investigation. Registering of a temporary death
certificate relieves the funeral director/direct disposer and certifier of possible violation of



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Florida Statutes and allows the burial-transit permit to be issued for disposition of the
decedent.

    A. Filing of temporary records:
       1. Should be registered before final disposition of the decedent, removal from state,
            or within five days after death or discovery of death;
       2. Must be completed with all information available at time of filing, except for the
            cause of death, and must be signed by the physician/medical examiner in charge
            of the case and the funeral director/direct disposer;
       3. The cause of death should be shown as "pending autopsy", "pending
            investigation," etc. followed by an estimated date of replacement;
       4. A death certificate on an unknown decedent is considered a temporary record.
            The filing of a record must not be held up while waiting for identification of the
            remains. If the decedent is subsequently identified, the record can be replaced
            with a permanent record as outlined below.
    B. Filing of permanent replacement records when the attending physician/medical
       examiner completes and determines the cause of death for a temporary death record
       already registered:
       1. When the attending physician or medical examiner completes and determines
            the cause of death for a temporary death record already registered or the identity
            of the decedent, a new and complete record is to be registered as soon as
            practical as a permanent replacement for the temporary record;
       2. Any information that was unknown or incorrect on the temporary record may be
            completed and/or corrected on the permanent record;
       3. Changed or corrected information must be documented on the back of the
            record, in the left margin, accompanied by either the funeral director's,
            physician's, or medical examiner's signature and date.
            e.g. “Items 4, 7 and 18 corrected. John Q. Funeral, LFD, 3/15/2004”

Temporary records can be amended prior to the filing of the permanent record. This is often
done when the family needs a certified copy right away and cannot wait for the permanent
record to be filed. Just be sure when the permanent record is filed that the information is in
agreement.

When the permanent replacement record is received while the local registrar still holds the
temporary record, it may be replaced at the local level. This replacement/permanent record
simply becomes an original record. The temporary record should be destroyed and only the
original (permanent replacement) record forwarded to the state office.

The local registrar should review the permanent record carefully to assure that all changes
have been authorized. If there are changes and there is no authorization, the record must
be returned to the funeral director for such authorization by the funeral director or physician.

UNIDENTIFIED BODIES

A death certificate must be registered for unidentified human remains. The decedent’s
name should be listed as “Unknown.” This certificate should show all known or approximate
facts related to the body. The medical examiner should provide all information concerning
the place and circumstances under which the body was found. That portion of the record
relating to medical certification of the cause of death should be competed to the extent
possible.


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An “Unknown” is considered a temporary record. If a body is later identified to the
satisfaction of the medical examiner and registrar, a new death certificate must be prepared.
This certificate will bear the same number as the original certificate and should be
processed as any permanent replacement of a temporary record.

ACCESS TO DEATH CERTIFICATES

Anyone may obtain a death certification without cause of death upon completion of an
application and payment of the appropriate county or state fee. Death certifications with
cause-of-death are confidential and issued to the authorized persons listed below, as
outlined in s. 382.025(2), F.S.:

    1. Decedent’s spouse or parent;
    2. Decedent’s child, grandchild, or sibling, if of legal age;
    3. Any person who provides a will, insurance policy or other document that
       demonstrates his or her interest in the estate of the decedent;
    4. Any person who provides documentation that he or she is acting on behalf of any of
       the above named persons; or
    5. Upon order of a court of competent jurisdiction; (s. 382.025(2), F.S.).

After 50 years from the date of death, cause of death information is no longer exempt from
s. 119.07 F.S. Anyone may obtain a certified copy showing cause of death on those
records.

FUNERAL DIRECTOR APPLICATION FOR DEATH CERTIFICATIONS

The funeral director, if representing an authorized person, may obtain the certification with
cause of death information. It is not required that the funeral director be associated with the
funeral home of record. As a licensed professional authorized in statute to represent
families, the Bureau of Vital Statistics recognizes this relationship, however, if the funeral
director misrepresents that relationship, it is a violation of statute and will be treated as such.

A generic funeral director application, DH 1969, and an Affidavit for Release of Cause-of-
Death Information, DH 1959, are available from the CDR. Instructions on how to complete
the forms are included on the form itself.

Applying at the state office -- the funeral director should use either:
   1. Application for Florida Death Record, DH 727, which can also be found on the vital
       statistics website at www.doh.state.fl.us OR
   2. Application for Florida Death Record (Funeral Director Use Only), DH 1969, which
       can be obtained from the local vital statistics office or from the state office.
   3. Applications should be completed in their entirety, including the funeral director
       license number, as well as the name of the person they represent and that person’s
       relationship to the decedent.

Applying at the county vital statistics office:
   1. When requesting certifications from the county vital statistics office where the funeral
       home is located, it is suggested that the funeral director use the county Application
       for Florida Death Record (CHD Use Only), DH 1961. This form is designed to
       include all specific information related to that county.


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    2. When the funeral director is requesting certifications from a county other than their
       home county, the Application for Florida Death Record (Funeral Director Use Only),
       DH 1969 should be used. It is the responsibility of the funeral director to ensure that
       the correct fees are provided with the application.
    3. Applications should be completed in their entirety, including the funeral director
       license number, as well as the name of the person they represent and that person’s
       relationship to the decedent.

The state office provides a county phone list that includes fees for certifications, addresses
and phone numbers for all 67 county vital statistics offices along with the names of the
Local, Chief and Deputy Registrars. This list is updated quarterly and found on the vital
statistics website at: http://www.doh.state.fl.us/planning_eval/vital_statistics/index.html.
The funeral director should verify all fees with the county office to ensure there have been
no changes since the last update.

CORRECTION OF DEATH CERTIFICATES

Non-medical amendment: Correction or amendment of filed death records can only be
made by the state office. Certain errors may be corrected by the Affidavit of Amendment to
Death Record (DH 433). In addition to the affidavit, documentary evidence is needed in
support of major corrections. Changes to marital status that affect the surviving spouse item
require a court order. A $20.00 statutory amendment fee is required and includes the
issuance of one certification of the amended record.

Medical amendments: The notarized Affidavit of Amendment to Medical Certification of
Death, DH 434A (for deaths in 2005 forward) or DH 434 (for deaths 2004 or older), is used
for any of these amendments. The form must be an original form; copies will not be
accepted.

Section 64V-1.007, F.A.C., states that the certifying physician or medical examiner must
make any change and/or correction to the Medical Certification of the Cause of Death. This
includes not only the cause of death and manner of death, but also “…the date of death,
hour or time of death or the place of death other than street address…”.
If there is an attending physician listed on the death certificate in item 35, that physician, as
well as the certifying physician listed in item 34b, has the authority to amend the cause of
death at any time, should it be necessary.

The medical affidavit is not the normal mechanism by which the medical examiner assumes
jurisdiction of a case recently filed with the state office. Contact the Chief Deputy Registrar
for assistance in these instances.

There is no amendment fee associated with a medical amendment; however, if a
certification of the amended death record is needed, a fee of $5.00 for the first copy and
$4.00 for each subsequent copy ordered at the same time is required. The Application for a
Florida Death Record, DH 727, is available on the website at:
http://www.doh.state.fl.us/planning_eval/vital_statistics/index.html

DELAYED DEATH CERTIFICATES

A delayed death record is filed for a death that occurred before the current or prior year.
The funeral director or person acting as such should file the record directly with the state


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office, furnishing a written explanation for the delay in filing on the back of the record. In the
case where a funeral home failed to file a death record with the vital statistics office, the
funeral home should assist the family with necessary paperwork to support the filing of a
delayed death record. The attending physician or medical examiner with current jurisdiction
must be available and willing to certify as to the cause of death. An amendment fee of
$20.00 is required and includes the issuance of one certification of the death record.

PRESUMPTIVE DEATHS

A presumptive death is a determination by a court of competent jurisdiction that a death of a
resident of this state has occurred or is presumed to have occurred, but the body of the
person involved has not been located or recovered; or a death of a nonresident of this state
has occurred or is presumed to have occurred in this state, but the body of the person
involved has not been located or recovered.

Presumptive death records are filed directly with the state office. The local registrar is not to
accept for registering a death record based upon a presumptive death. The state office will
accept for filing a presumptive death record when so ordered by a court of competent
jurisdiction and the judge issuing the order signs the medical certification (s. 382.012, F.S.).
Since there is no body, the services of a funeral director are not required.

Examples of situations when a presumptive record would be filed are a drowning accident in
which the remains were never recovered, a person leaves for the store and is never heard
from again, a plane crash in the ocean where no body is recovered, etc. Normally the family
or their legal representative initiates the filing of a presumptive death record. A packet of
information on filing procedures is available from the state office




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CREMATION

It is unlawful for any person, firm, or corporation to cremate any dead human body prior to
the expiration of 48 hours after the death of such human body and without the consent of
the appropriate medical examiner. (Refer to s. 872.03(1), F.S., Offenses Concerning Dead
Bodies and Graves)

If a body is removed from state and the funeral director knows that cremation will be the final
disposition, the medical examiner must grant approval. If death occurs in another state and
the remains are brought into Florida and to be cremated once in the state, the medical
examiner must also grant approval before cremation can proceed. The consent process
may differ from one district to another. Written consent is required in some districts whereas
telephone approval may be sufficient in other districts. However, in no district will written
approval be made in the death certificate margins or in such a way to deface the record.

When the above conditions are met, the burial-transit permit will be considered authority to
cremate in accordance with the wishes of the next-of-kin. Immediately following cremation,
the permit should be handled as though burial had taken place and returned to the county
wherein cremation took place. Following cremation, no further permit is needed for any
disposition of the cremated remains within our state.

BURIAL OF HUMAN REMAINS AT SEA (EPA REGION 4)

According to federal regulations (40 CFR 229.1 (PDF) (1 p, 149K, About PDF) based on the
Marine Protection, Research and Sanctuary Act of 1972, human remains transported from
United States ports or on United States vessels or aircraft may be buried at sea under
specified conditions

These include cremated as well as non-cremated remains. Details on the specific
requirements, preparation of the body, disposal location and measures, forms to be filed
with the EPA, can be found at: http://www.epa.gov/region4/water/oceans/burial.htm

TRANSPORTATION OF BODIES

A dead human body shall be transported only when accompanied by a completed burial-
transit permit.

A dead human body transported by common carrier or agencies or individuals authorized to
carry human bodies must be placed in a carrying container adequate to prevent the
seepage of fluids and escape of offensive odors. No particular type container or casket
meeting this requirement is specified.

DEAD BODY TRANSPORTED FROM OUTSIDE THE STATE

When a dead body is transported from outside the state into a county in Florida for burial,
the burial-transit permit issued in accordance with the laws and health regulations of the
place where the death occurred shall be given the same force and effect as a local permit,
and no other permit shall be required. If a dead body is brought into the state from a
location that does not issue burial permits, a certification of the death record may be used
instead of a burial permit.



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UNCLAIMED BODIES

See Chapter 406, Part II F.S., regarding disposition of unclaimed dead human bodies.

BODIES DONATED TO MEDICAL SCIENCE

Inquiries concerning donation of decedents’ remains after death should be directed to:
        Anatomical Board of the State of Florida
        University of Florida College of Medicine
        P.O. Box 100235
        Gainesville, Florida 32610-0235
                        OR
        University of Miami School of Medicine
        Department of Cell Biology and Anatomy
        P.O. Box 016960 (R-124)
        Miami, Florida 33101
The above applies only to those who wish to donate their bodies after death for promotion of
medical science within this state. Those wishing to be donated to out-of-state institutions
should be instructed to contact the receiving institution directly.

DEATH THAT OCCURS IN ANOTHER COUNTY (REGISTRATION DISTRICT)

Local registrars are not to accept death certificates presented by funeral directors/direct
disposers that did not occur in their county, nor to accept permits for disposition.

DEATH THAT OCCURS OUTSIDE OF FLORIDA

Local registrars are not to accept death certificates for deaths occurring outside Florida,
whether U.S. citizens or not. This has particular application to death certificates presented
by military authorities where the deceased died outside the United States and the decedent
has been returned to Florida. This does not preclude acceptance of a proper death
certificate of a death occurring in a Florida port or aboard ship or other moving conveyance
where the body is first removed from the conveyance into a Florida county.




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                                 CHAPTER 5 – PREPARING THE DEATH CERTIFICATE



            CHAPTER 5 – PREPARING THE DEATH CERTIFICATE
DETAILED INSTRUCTIONS FOR PREPARING THE DEATH CERTIFICATE

Under state law, the completion of the death certificate is the responsibility of the funeral
director/direct disposer or whoever first assumes custody of the body. This is true even
though the physician/medical examiner completes the medical portion of the certificate. The
record must be typewritten in black ink and has tabs in the margin indicating who is
responsible for completion of the delineated information.

It is important that the information is easily readable. The following instructions and
information will be helpful in filling out the death certificate. The items are numbered to
conform to the Florida death certificate.


                               DEMOGRAPHIC SECTION OF RECORD
                            TO BE COMPLETED BY FUNERAL DIRECTOR

The demographic portion of the death record is, generally, the personal information the
funeral director gathers at the time of the initial preparation of the record.

1. DECEDENT'S NAME (First, Middle, Last)

Enter and space out the full first, middle, and last names of the decedent. Do not
abbreviate. Do NOT use titles, i.e., General, Sister, Father, Doctor, Lord, etc. (Occupation,
item 15a-b, can reflect this information as related). If the decedent’s name was simply
initials, such as “J. C. Harris” or “F. Lee Bailey”, then that is how the name should be
entered on the record. If decedent’s name is not known, “Unknown” should be entered.
Entries of Jr., II, etc., following the last name are acceptable. If there is no middle name,
leave this space blank. Do not enter “no middle name” or “NMN.”

If the deceased used an alias or AKA (Also Known As), the funeral director/direct disposer
should complete item 1 according to the following instructions:

         AKA: John Q. Public

This entry must appear in item 1, above the name originally entered. If space allows, the
AKA may follow the name, but there must be several spaces between the last name and the
beginning of the AKA in order to differentiate between the two names. If more than one
AKA is required, enter original first, middle, and last names as provided above, enter above
these names "AKAs recorded on back of certificate." The AKA should be neatly entered on
the back of the certificate, about 1/3 down the page, in the sample, below line 43a, in that
blank box. This is to ensure that the record will be properly indexed under the original name
and not the AKA (s. 382.008(1)(a) F.S.).

If the decedent is under 30 days old and the parents have not selected given names, enter
the surname only. Do not enter "Baby Boy" or "Infant Girl."

THIS ITEM IS USED TO IDENTIFY THE DECEDENT FOR WHOM THE CERTIFICATE IS
BEING PREPARED.



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2. SEX

Enter male or female. Do not abbreviate or use other symbols. If sex cannot be determined
after verification with medical records, inspection of the body, or other sources, enter
"Unknown."

THIS ITEM HELPS IN THE IDENTIFICATION OF THE DECEDENT. IT IS ALSO USED IN
RESEARCH AND STATISTICAL ANALYSIS OF MORTALITY OF THE MALE AND
FEMALE POPULATIONS.

3. DATE OF BIRTH (Month, Day, Year)

Enter the exact month, day, and year that the decedent was born. Enter the full or
abbreviated name of the month (Jan., Feb., Mar., etc.). Do not use a number for the month.
If age is unknown, enter “Unknown.”

THIS ITEM IS USEFUL IN IDENTIFICATION OF THE DECEDENT FOR LEGAL
PURPOSES.

4a-c. AGE

Make one entry in 4a, 4b, or 4c, depending on the age of the decedent.

4a. AGE-Last Birthday (Years)

Enter the age of the decedent at last birthday. If the decedent was under one year of age,
leave this item blank.

4b. UNDER 1 YEAR (Months, Days)

Enter the age of the infant in months or days at time of death. If the infant was between 1
and 11 months of age inclusive, enter the age in completed months. If the infant was less
than 1 month old, enter the age in days. If the infant was over 1 year or less than 1 day of
age, leave this item blank.

4c. UNDER 1 DAY (Hours, Minutes)

Enter the number of hours or minutes the infant lived. If the infant was between
1 and 23 hours old, inclusive, enter the age in completed hours. If the infant was less than 1
hour old, enter age in minutes. If the infant was more than 1 day old, leave this item blank.

AGE IS ONE OF THE MOST IMPORTANT CHARACTERISTICS IN STUDYING
MORTALITY. THE "UNDER 1 YEAR" AND "UNDER 1 DAY" PORTIONS PROVIDE
INFORMATION FOR EVALUATION OF INFANT, NEONATAL, AND PERINATAL
MORTALITY.

5. DATE OF DEATH (Month, Day, Year)

Enter month, day, and year that death occurred. Enter the full or abbreviated name of the
month (Jan., Feb., Mar. etc.). Do not use a number for the month. Pay particular attention


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to the entry of month, day, and year when the death occurs around midnight or
December 31. Consider a death at midnight to have occurred at the beginning of the
following day rather than the end of that day.

If the date of death is unknown, enter the date the body was discovered; the words "found
on" should be entered in item 5, above the date of death.

THIS ITEM IS USED IN CONJUNCTION WITH THE TIME OF DEATH TO ESTABLISH THE
EXACT TIME OF DEATH OF THE DECEDENT. IT ALSO PROVIDES DATA FOR
RESEARCH INTO DATE OF DEATH AS IT RELATES TO OTHER ITEMS ON THE
CERTIFICATE.

6. SOCIAL SECURITY NUMBER

Enter the United States social security number, or Canadian equivalent, of the decedent. If
the decedent has neither, enter “None.” If the social security number is not known, enter
“Unknown.” Do not leave blank.

THIS ITEM IS USEFUL IN IDENTIFYING THE DECEDENT AND FACILITATES THE
FILING OF SOCIAL SECURITY CLAIMS. IT IS IMPORTANT TO HAVE A VALID NUMBER
IN ORDER TO PREVENT DELAYS IN PROCESSING OF CLAIMS.

7. BIRTHPLACE (City and State, or Foreign Country)

If the decedent was born in the United States, enter the name of the city and state or county
name and state, if a rural area. Do not enter the city or county name by itself; always
include the state. If only the state is known and not the city, enter “Unknown, Alabama”. If
the city and state are both unknown, enter "U.S. - Unknown."

If the decedent was not born in the United States, enter the name of the country of birth. If
the country is unknown, enter "Foreign - Unknown."

Enter the name of the place of birth in full. Do not use abbreviations, unless necessary and
then only the longest form of the abbreviation is acceptable.

If no information is available regarding place of birth, enter "Unknown."

THIS ITEM IS USED TO MATCH BIRTH AND DEATH CERTIFICATES OF A DECEASED
INDIVIDUAL. MATCHING THESE RECORDS PROVIDES INFORMATION FROM THE
BIRTH CERTIFICATE THAT IS NOT LISTED ON THE DEATH CERTIFICATE AND MAY
GIVE INSIGHT INTO WHICH CONDITIONS LED TO DEATH. INFORMATION FROM THE
BIRTH CERTIFICATE IS ESPECIALLY IMPORTANT IN EXAMINING THE CAUSES OF
INFANT MORTALITY.




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8. COUNTY OF DEATH

Enter the name of the county where death occurred.

If the death occurred on a moving conveyance in the United States and the body was first
removed from the conveyance in this state, enter the county where the body was first
removed from the conveyance.

If the death occurred on a moving conveyance in international waters, international airspace,
or in a foreign country or its airspace and the body was first removed from the conveyance
in this state, register the death in the county where the body was first removed from the
conveyance.

INFORMATION ON PLACE OF DEATH IS NEEDED TO DETERMINE WHO HAS
JURISDICTION FOR DEATHS THAT LEGALLY REQUIRE INVESTIGATION BY A
MEDICAL EXAMINER. THESE ITEMS ARE ALSO USED FOR RESEARCH AND
STATISTICS COMPARING HOSPITAL AND NON-HOSPITAL DEATHS. VALUABLE
INFORMATION IS PROVIDED FOR HEALTH PLANNING AND RESEARCH ON THE
UTILIZATION OF HEALTH FACILITIES.

9. PLACE OF DEATH (Check only one)

Check the type of place where death occurred:
       HOSPITAL: __ Inpatient __ Emergency Room/Outpatient __ Dead on Arrival

A state mental hospital that provides long-term psychiatric care would be classified as a
"Hospital" and "Inpatient" would be the appropriate item to check.

         NON-HOSPITAL:
         __ Hospice Facility – see detailed instructions below.
         __ Nursing Home/Long Term Care Facility -- If death occurred at a nursing home
              or licensed long-term care facility offering skilled nursing care that is not a
              hospital, check this item. If death occurred at a licensed ambulatory/surgical
              center or birthing center, check "Other (Specify)."
         __ Decedent’s Home -- If death occurred at the residence of the deceased,
              check the "Decedent’s Home" item. An ALF/ACLF (Adult Congregate Living
              Facility) or other assisted living facility may be considered as the decedent’s
              residence.

                   If death occurred at any other residence, check "Other (Specify)." If not the
                   full-time residence of the decedent, "Other" should be checked and "winter
                   residence,” "vacation home,” “friend’s residence”, etc. should be entered.
         __        Other (Specify) -- specify location, for example, physician's office, highway,
                   shopping center, office building, daughter's house, Gulf of Mexico,
                   ALF/ACLF, etc. If the decedent's body was “found”, the place where the
                   body was found should be entered as the place of death.




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HOSPICE DEATHS

It is important to be able to determine the number of deaths that occur in a hospice;
accurate data is vital. There are three different hospice situations and below are
instructions for each:
     1. Freestanding hospice facility – a separate building that operates independent of any
         hospital. The preparer should complete the record as follows:
              Item 9, Place of Death, NON-HOSPITAL: Hospice Facility
              Item 10, Facility Name -- should be completed with the name of the hospice,
              such as Earl Hadlow Community Hospice.
     2. Hospice unit within a hospital – hospice actually is part of the hospital or is a unit of
         the hospital. The preparer should complete the record as follows:
              Item 9, Place of Death, HOSPITAL: Inpatient
              Item 10, Facility Name – should be completed with the name of the hospital only,
              such as Broward General Medical Center, in order for the data to be captured as
              a hospital inpatient death as directed by the National Center for Health Statistics
              (NCHS).
     3. Hospice located within the confines of the hospital, but not part of the hospital -- if
         they rent/lease the space from the hospital, a simple business arrangement, then the
         hospice is not actually part of the hospital, but is a hospice facility and should be
         treated as a “freestanding” facility. The preparer should complete the record as
         follows:
              Item 9, Place of Death, NON-HOSPITAL: Hospice Facility
              Item 10, Facility Name – Enter only the name of the hospice, such as J. Robert
              Lauer Hospice. Do not enter the hospital name in order for the data to be
              captured as a hospice death as directed by NCHS.

There is also the possibility that a nursing home may have a hospice unit on the premises.
The same rationale applies. If the nursing home has a unit designated as a hospice unit,
but is part of the nursing home, Nursing Home/Long Term Care Facility must be checked.
    1. Hospice unit within a nursing home – hospice actually is part of the nursing home or
        is a unit of the nursing home. The preparer should complete the record as follows:
            Item 9, Place of Death, NON-HOSPITAL:            Nursing Home/Long Term Care
            Facility
            Item 10, Facility Name – should be completed with the name of the nursing
            home only, such as Park Ridge Nursing Home, in order for the data to be
            captured as a nursing home death as directed by NCHS.
    2. Hospice located within the confines of the nursing home, but not part of the nursing
        home -- if they rent/lease the space from the nursing home, a simple business
        arrangement, then the hospice is not actually part of the nursing home, but is a
        hospice facility and should be treated as a “freestanding” facility. The preparer
        should complete the record as follows:
            Item 9, Place of Death, NON-HOSPITAL: Hospice Facility
            Item 10, Facility Name – Enter only the name of the hospice, such as Lasting
            Care Hospice. Do not enter the nursing home name in order for the data to be
            captured as a hospice death as directed by NCHS.




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10. FACILITY NAME (If not institution, give street and number)

A. Hospital Deaths:
   1. In a hospital, enter the full name of the hospital.
   2. En route to or on arrival at a hospital, enter the full name of the hospital. Deaths that
      occur in an ambulance or emergency vehicle en route to a hospital fall into this
      category.

B. Non-hospital Deaths:
         a. In a hospice facility, see detailed instructions under item 9, Place of Death,
             Hospice Deaths.
         b. In a nursing home/long term care facility, enter the name of the facility.
         c. At decedent’s home or at a residential address, enter the house number and
             street name.
         d. In an ALF/ACLF or assisted living facility, enter either the street address
             and/or the facility name.
         e. Some place other than those described above, enter the number and street
             name of the place.
         f. At Sea/Air, enter the name of the vessel, for example, "S.S. Emerald Seas (at
             sea)" or "Delta Airlines Flight 296 (in flight)." (At sea = more than 24 miles off
             the coast, per U.S. Coast Guard).
         g. In a body of water, such as Gulf of Mexico or Atlantic Ocean, and the body is
             picked up and brought ashore, the place of death should be wherever the
             body was brought ashore. Enter the latitude and longitude, if available, or the
             best geographical indicators, such as, “7 miles off the coast of Clearwater.”
         h. On a moving conveyance in the United States and the body was first
             removed from the conveyance in this state, enter as the place of death the
             address where the body was first removed from the conveyance.
         i. In an area with no known address (such as a rural area, in the woods), enter
             the best geographical markers available, for example, “2 miles north of mile
             marker 7, Highway 17.”
         j. Do not enter a Post Office Box for place of death.

11a. CITY, TOWN, OR LOCATION OF DEATH

Enter the name of the city, town, or location where death occurred. Do not abbreviate.

If the death occurred on a moving conveyance in international waters, international airspace,
or in a foreign country or its airspace and the body was first removed from the conveyance
in this state, enter “Sea/Air.”

11b. INSIDE CITY LIMITS?

Enter "Yes" if the place of death listed in item 9a is within the city limits of the city/town listed
in 11, otherwise, enter "No."




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12 MARITAL STATUS - Married, Married but Separated, Never Married, Widowed,
Divorced (Specify)

Check the marital status of the decedent at time of death. Common law marriages are not
recognized in Florida. If marital status cannot be determined, enter "Unknown."

If “Simultaneous Death” (see item 13), and the couple is legally married at that time, status
should be “Married”.

THIS ITEM IS USED TO STUDY DIFFERENCES IN MORTALITY FOR MARITAL STATUS
GROUPS.

13. SURVIVING SPOUSE (If wife, given maiden name)

If decedent was married at time of death, enter name of surviving spouse. If the surviving
spouse is the wife, give full maiden name.

If both husband and wife die at the same time or exact time of death cannot be determined,
“Simultaneous Death” may be entered, along with the name of the spouse; item 12, Marital
Status should indicate “Married”. This can only be decided by the medical examiner.

THIS ITEM AIDS IN THE ESTABLISHMENT OF THE RELATIONSHIP OF SURVIVING
SPOUSE TO THE DECEDENT FOR THE PURPOSE OF INSURANCE AND OTHER
SURVIVOR BENEFITS.

14a-g RESIDENCE OF DECEDENT

This is the geographic location of the usual place of residence of the deceased. The usual
residence of a decedent means the city, town, or location where the deceased lived prior to
death.
    1. If the deceased was military personnel and lived in a city, town, or location one year
        or more, his or her usual residence would be that city, town, or location.
    2. If deceased lived in a city, town, or location less than one year, his or her home
        address prior to that address should be given.
    3. If the deceased is a child, his or her residence should be given as that of his or her
        mother, legal guardian, or custodial agency.
    4. If the child was born in a hospital or institution and died there before leaving, his or
        her residence should be given on the death record as that of his or her mother and
        as was shown on the birth record.
    5. If deceased was a transient, residence is specified as the place he considered his or
        her regular home. If residence is not known, enter “Unknown”.
    6. In the case of patients of tuberculosis sanitariums, mental hospitals, nursing and
        convalescent homes, and other institutions in which patients remain for some time,
        the place where the deceased lived prior to admission should be reported.
    7. If the deceased was a resident of the United States, the name of the state is entered.
        If a foreign resident, the name of the country in which he was a resident is given.




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14a. RESIDENCE - STATE

Enter the name in full. Do not use abbreviations, unless necessary and then only the
longest form of the abbreviation is acceptable.

14b. COUNTY

Enter the name in full. Do not use abbreviations, unless necessary and then only the
longest form of the abbreviation is acceptable.

14c. CITY, TOWN, OR LOCATION

When residence is inside city limits of a city or town, give the name of the city or town,
regardless of size. When residence is outside city limits of a city or town, give name of the
suburban area or the name of the community in this space. Do not use abbreviations,
unless necessary and then only the longest form of the abbreviation is acceptable.

14d. STREET ADDRESS

Enter in full. Do not use abbreviations, unless necessary and then only the longest form of
the abbreviation is acceptable. A Rural Route and Box Number is acceptable, but a Post
Office Box Number is not acceptable. When there is no street address, give best
geographical location.

14e APT. NO.

If the decedent lived in an apartment or other type multiunit building, enter the unit number.
If there is no apartment number this item should be left blank.

14f ZIP CODE

Enter the five-digit zip code of the place where the decedent lived. This may differ from the
zip code used in the mailing address.

14g. INSIDE CITY LIMIT?

Check "Yes" if residence is inside city limits. Check "No" if residence is not inside city limits.

CORRECT INFORMATION ON DECEDENT’S RESIDENCE IS IMPORTANT AND
MEANINGFUL IN THE COMPUTATION OF DEATH RATES. MANY PERSONS GO FOR
MEDICAL CARE TO AN AREA HAVING HOSPITAL OR MEDICAL CENTER FACILITIES,
AND CONSEQUENTLY, DEATH RATES BY PLACE OF RESIDENCE ARE NEEDED TO
REFLECT THE TRUE MORTALITY EXPERIENCE OF A POPULATION. WHERE
CERTAIN COMMUNICABLE DISEASES ARE INVOLVED, THE PLACE OF RESIDENCE IS
ESSENTIAL AS A STARTING POINT IN TRACING THE SOURCE OF INFECTION.




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15a-b. OCCUPATION AND INDUSTRY OF DECEDENT

These items are to be completed for all decedents. Enter the information even if the
decedent was retired, disabled, or institutionalized at time of death.

If a decedent has used a title in conjunction with their name, “Occupation and Industry” is a
mechanism by which this fact can be reflected on the record (titles cannot be used in
item 1, “Decedent’s Name”), for example, General Thomas Jones – 15a “general”, 15b
“U.S. Army” or “U. S. armed services”.

15a. DECEDENT'S USUAL OCCUPATION (Indicate type of work done during most of
working life. Do not use “Retired”)

Enter the usual occupation of the decedent. This is not necessarily the last occupation of
the decedent. "Usual occupation" is the kind of work the decedent did during most of his/her
working life, such as claims adjuster, farmhand, coal miner, housewife, janitor, store
manager, college professor, civil engineer, etc.

If the decedent was:
     1. A homemaker at the time of death, but had worked outside the household during his
        or her working life, enter that occupation;
     2. A homemaker during most of his or her working life and never worked outside the
        household, enter "Homemaker”;
     3. Student at the time of death and never regularly employed, enter "Student”;
     4. Infant, enter “never worked”;
     5. Disabled or for other reasons has never been employed, enter “Never worked.”

15b. KIND OF BUSINESS/INDUSTRY

Enter the kind of business or industry to which the occupation listed in item 10a was related,
such as insurance, farming, coal mining, hardware store, retail clothing, university,
government, etc. Do not enter firm or organization names. If decedent never worked as
stated above, enter “None.”

THESE ITEMS ARE USEFUL IN STUDYING OCCUPATION RELATED MORTALITY AND
IN IDENTIFYING JOB-RELATED RISK AREAS. FOR EXAMPLE, CORRELATING
ASBESTOS USED IN PARTICULAR OCCUPATIONS IN THE SHIPBUILDING INDUSTRY
TO RESPIRATORY CANCER WAS POSSIBLE WITH THIS INFORMATION.

16. DECEDENT’S RACE (Specify the race/races to indicate what the decedent
considered himself/herself to be. More than one race can be specified)

Check the race as obtained from the informant. Mark all entries that apply. Complete
“other, specify” as needed, e.g. Hispanic. If not known, enter Unknown after item heading
line. Do not leave this item blank.

THIS ITEM ALLOWS FOR MULTIPLE ENTRIES FOR “RACE” IN ORDER TO OBTAIN
INFORMATION THAT IS MORE SPECIFIC. IT IS USED TO STUDY HEALTH
CHARACTERISTICS FOR RACIAL GROUPS. RACE IS AN IMPORTANT VARIABLE IN
PLANNING FOR AND EVALUATING THE EFFECTIVENESS OF HEALTH PROGRAMS.



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17. DECEDENT OF HISPANIC OR HAITIAN ORIGIN? (Specify if decedent was of
Hispanic or Haitian Origin

Check only one. Specify “Yes” or "No." If "Yes" is checked, indicate the appropriate choice
as provided by the informant. If there is more than one, check Other Hispanic (Specify) and
enter Puerto Rican/Cuban or Mexican/Guatemalan, etc. If not known, enter Unknown after
item heading line. Do not leave this item blank.

For the purposes of this item, "Hispanic" refers to those people whose origins are from
Spain, Mexico, or the Spanish-speaking countries of Central or South America. Origin can
be viewed as the ancestry, nationality, lineage, or country in which the person or his or her
ancestors were born before their arrival in the United States.

There is no set rule as to how many generations are to be taken into account in determining
Hispanic or Haitian origin. A person may report Hispanic or Haitian origin based on the
country of origin of a parent, grandparent, or some far-removed ancestor. The response
should reflect what the person considers himself or herself to be and is not based on
percentages of ancestry. Although the prompts include the major Hispanic groups of
Cuban, Mexican, and Puerto Rican, other Hispanic groups should also be identified in the
space provided.

This item is not a part of the Race item. A person of Hispanic origin may be of any race.
Each question, Race and Hispanic origin, should be asked independently.

HISPANICS COMPRISE THE LARGEST ETHNIC MINORITY IN THIS COUNTRY, AND IN
FLORIDA, HAITIANS ALSO COMPRISE A LARGE MINORITY. RELIABLE DATA ARE
NEEDED TO IDENTIFY AND ASSESS PUBLIC HEALTH PROBLEMS OF THESE
GROUPS AND TO TARGET EFFORTS TO THEIR SPECIFIC NEEDS. INFORMATION
FROM ITEM 14 WILL PERMIT THE PRODUCTION OF MORTALITY DATA FOR THE
HISPANIC/HAITIAN POPULATIONS.

18. DECEDENT'S EDUCATION (Specify decedent’s highest level of school completed
at time of death)

Mark the appropriate line that reflects the level of education of the decedent. Count formal
schooling. Do not include beauty, barber, trade, business, technical, or other special
schools in this entry.

If decedent is:
    1. From another country and has completed secondary education (high school), check
       High school diploma or GED
    2. Infant and never attended school, check 8th grade or less.
    3. Disabled and never attended school, check 8th grade or less

THIS ITEM IS USED IN STUDIES OF THE RELATIONSHIP BETWEEN EDUCATION AND
MORTALITY AND PROVIDES AN INDICATOR OF SOCIOECONOMIC STATUS, WHICH
IS ALSO CLOSELY ASSOCIATED WITH MORTALITY. THIS INFORMATION IS
VALUABLE IN MEDICAL STUDIES OF CAUSES OF DEATH AND IN PREVENTION
PROGRAMS.

19. WAS DECEDENT EVER IN U.S. ARMED FORCES? Yes or No


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Check "Yes" or "No." If the information is unknown, so state. This would include merchant
seaman who served in active oceangoing service between December 7, 1941 and
August 15, 1945. Civil Service crewmembers aboard US Army Transport Service and Naval
Transportation Service vessels are eligible for benefits. Do not leave this item blank.

THIS ITEM IS USED TO IDENTIFY DECEDENTS WHO WERE VETERANS AND IS OF
INTEREST TO VETERAN GROUPS AS WELL AS FAMILIES TRYING TO OBTAIN
VETERAN’S BENEFITS.

20-21. PARENTAGE

If parentage is unknown, do not leave these items blank; enter ”Unknown”, “Unavailable” or
“Unobtainable.”

20. FATHER'S NAME (First, Middle, Last, Suffix)

Enter the full name of the father of the decedent. If last name is unknown, enter
“Unavailable” as the last name.

21. MOTHER'S NAME (First, Middle, Maiden Surname)

Enter the full maiden name of the mother of the decedent. This is the name given at birth or
subsequent court directed legal name change, not a name acquired by marriage. If maiden
name is unknown, enter “Unavailable” as the maiden name.

THE NAMES OF THE DECEDENT'S MOTHER AND FATHER AID IN IDENTIFICATION OF
THE DECEDENT. THESE ITEMS ARE ALSO OF IMPORTANCE IN THE TRACING OF
FAMILY GENEALOGY.

22a-b. IDENTITY OF INFORMANT

22a. INFORMANT'S NAME

Enter the name of the person who supplied the personal facts about the decedent and his or
her family.

If the decedent pre-arranged his/her funeral arrangements, the name of the decedent may
be placed in item 22a, e.g. John Doe (pre-arranged) or the name of the funeral home may
be entered in item 22a, e.g. Smith Funeral Home Records (pre-arranged).

There may be instances where item 22a may be completed with the name of a medical
institution, social worker, police record, or medical examiner. These entries are acceptable
with item 23a-d listing the address of the police facility, medical institution, or medical
examiner's office.

22b. RELATIONSHIP TO THE DECEDENT

Enter the relationship of the informant to the decedent, e.g. spouse, daughter, sister,
neighbor, friend, etc.



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23a-d – INFORMANT’S ADDRESS

23a. INFORMANT’S MAILING - STATE

Enter the name of the state where the informant receives mail.

23b. CITY OR TOWN

Enter the name of the city or town where the informant receives mail.

23c. STREET ADDRESS

Enter the correct street address of the informant. A post office box is acceptable for an
address for the informant.

23d. ZIP CODE

Enter the correct zip code of the address provided in 20e.

THE NAME, RELATIONSHIP AND MAILING ADDRESS OF THE INFORMANT ASSISTS IN
IDENTIFYING THE INFORMANT AND ARE USED TO CONTACT THE INFORMANT
WHEN INQUIRIES MUST BE MADE TO CORRECT OR COMPLETE ANY ITEMS ON THE
DEATH CERTIFICATE.

24. PLACE OF DISPOSITION (Name of cemetery, crematory, or other place)

Enter the name of the cemetery, crematory, or other place of final disposition. If the body
was removed to another state, specify the name of the cemetery, crematory, or other place
of disposition in that state to which the body was removed.

If the body is to be used by a hospital or a medical or mortuary school for scientific or
educational purposes, give the name of that institution. If the hospital makes final
disposition of the remains, enter the name of that institution.

25a-b. – LOCATION OF PLACE OF FINAL DISPOSITION

25a. LOCATION - STATE

Enter the state where the place of disposition is located.




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25b. LOCATION – CITY OR TOWN

Enter the city or town where the place of disposition is located.

If body is to be used for scientific or educational purposes, enter the name of the city or
town, where institution is located. If the hospital makes final disposition of the remains, give
the name of the city or town and where institution is located.

26a. METHOD OF DISPOSITION

Check the box corresponding to the method of disposition of the decedent's body. Only one
box should be checked:

         __      Burial
         __      Entombment (Includes Mausoleum)
         __      Cremation
         __      Removal from State -- The term "Removal" is used when a body is moved out
                 of state (do not also check “burial” “cremation”, etc. – Removal equals Final
                 Disposition for statistical; tabulation based on NCHS guidelines).
         __ Donation -- If the body is to be used by a hospital or a medical or mortuary
                 school for scientific or educational purposes, enter "Donation" and specify the
                 name and location of the institution in items 24 and 25a-b.
         __ Other (Specify) -- Specify the type of disposition (e.g., Storage, Burial-at-Sea,
                 Calcination, Hospital Disposition etc.). If a body is to be buried at sea, type in
                 item 26a "Burial-at-Sea," item 24 should be completed with the name of the
                 body of water (e.g., Atlantic Ocean), and item 25a-b should be completed
                 with the county name (e.g., coast of Duval County, Florida).
If the funeral director knows that, after a body is to be removed from state, cremation,
donation or burial at sea will be utilized, the funeral director should obtain the approval from
the medical examiner of the district in which the death occurred.

THESE ITEMS INDICATE WHETHER THE BODY WAS PROPERLY DISPOSED OF AS
REQUIRED BY LAW AND IS USED TO STUDY TRENDS AND DIFFERENCES IN TYPES
OF DISPOSITION.

26b. IF CREMATION, DONATION OR BURIAL AT SEA, WAS MEDICAL EXAMINER
APPROVAL Granted? Yes or No

If final disposition was cremation, donation or burial at sea, has medical examiner approval
been granted? Answer Yes or No. This item must be in agreement with the entry shown in
26a.

In the event you receive a record with any of the dispositions listed above and item 26b has
a "No" entry, the subregistrar should contact the medical examiner immediately, inform
him/her of the case, and receive the necessary approval. The funeral director/subregistrar
who notifies the medical examiner should strike through the word No in item 26b, indicate
"Yes,” and initial. If the chief or deputy registrar notes this discrepancy, they should proceed
as indicated, contact the medical examiner, make the change as indicated and file the
record.



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Upon notification, before granting approval, the medical examiner may ask to see a copy of
the record in order to review the cause of death. If the physician has entered the cause of
death as Unknown, the medical examiner may not grant approval until there is a more
definitive diagnosis. He/she may wish to contact the attending physician for more
information and/or may decide to accept jurisdiction and certify a new death certificate
based on what is learned. This action should be decided by the medical examiner.

THIS ITEM DIFFERENTIATES BETWEEN NOTIFYING THE MEDICAL EXAMINER BASED
ON FINAL DISPOSITION RATHER THAN FOR CAUSE OF DEATH AS SPECIFIED IN
ITEM 40. THESE ARE TWO ENTIRELY DIFFERENT PROCESSES.

27a-b. -- FUNERAL SERVICE LICENSEE/FACILITY

27a. LICENSE NUMBER (of Licensee)

Enter the personal state license number of the funeral service licensee (FD, FE, or KA). If
some person other than a licensed funeral director or direct disposer assumes custody of
the body, enter "None." An entry of None would be used only when the family or their
representative is assuming custody of the decedent or the medical examiner’s office or other
medical institution is storing or disposing of the body.

27b. SIGNATURE OF FUNERAL SERVICE LICENSEE OR PERSON ACTING AS SUCH

The funeral service licensee or other person first assuming custody of the body and who is
charged with the responsibility for completing the death certificate should sign here. If there
is no funeral director involved, have the person who assumes custody of the decedent sign
the record, for example, pathologist at hospital where remains have been donated for
scientific study or medical examiner/medical examiner representative when body is held in
storage at the ME’s office.

THESE ITEMS IDENTIFY THE PERSON WHO IS RESPONSIBLE FOR REGISTERING
THE CERTIFICATE WITH THE REGISTRAR.

28. NAME OF FACILITY

Enter the name and address of the facility handling the body prior to burial or other
disposition.

29a. FACILITY’S MAILING - STATE

Enter the state where the establishment receives mail.

29b. CITY OR TOWN

Enter the city or town where the establishment receives mail.




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29c. STREET ADDRESS

Enter the street address of the establishment.

29d. ZIP CODE

Enter the zip code of the address listed in item 29c.

THESE ITEMS IDENTIFY THE ESTABLISHMENT THAT IS RESPONSIBLE FOR
REGISTERING THE CERTIFICATE WITH THE REGISTRAR.

30. CERTIFIER (check one)

         __        Certifying Physician – To the best of my knowledge, death occurred at the
                   time, date and place, and due to the cause(s) and manner stated.
         __        Medical Examiner – On the basis of examination, and/or investigation, in my
                   opinion, death occurred at the time, date and place, due to the cause(s) and
                   manner stated.

Check the appropriate box. If the certifier is a private physician, check the box “Certifying
Physician.” If it is a medical examiner case, “Medical Examiner” should be checked. See
instructions for item 40 to determine if case falls under medical examiner jurisdiction.

31a. (Signature and Title of Certifier)

The physician who certifies to the death signs the certificate. The signature should be
followed by degree or title of the physician.

31b. DATE SIGNED (mm/dd/yyyy)

Enter the numerical month, day, and year that the certifier signed the certificate.

32. TIME OF DEATH (24 hr.)

The physician should enter the exact time of death in the 24-hour clock format. Enter the
exact time the decedent died, according to local time. If daylight savings time is the official
prevailing time when death occurs, it should be used to record the time of death.

Enter 12 noon as "1200." One minute after 12 noon is entered as "1201". Enter
12 midnight as "0000". One minute after 12 midnight is entered as "0001". Remember that
midnight is the beginning of the new day.

ESTABLISHES THE EXACT TIME OF DEATH, WHICH CAN BE IMPORTANT IN
INHERITANCE CASES WHEN THERE IS A QUESTION OF WHO DIED FIRST. THIS IS
OFTEN IMPORTANT IN THE CASE OF MULTIPLE DEATHS IN THE SAME FAMILY.

33. MEDICAL EXAMINER’S CASE NUMBER

Case number is to be entered by medical examiner. If none is given, leave blank.

34a. LICENSE NUMBER of CERTIFIER


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Enter the license number of the physician certifying the medical certification of cause of
death.

34b. CERTIFIER’S NAME

Enter the name of the certifier.

35. NAME OF ATTENDING PHYSICIAN (if other than Certifier)

If the certifier was not the attending physician, enter the name of the attending physician
here. If the certifier is the attending physician, no entry is necessary.

IF THERE IS AN ATTENDING PHYSICIAN LISTED, THAT PHYSICIAN, AS WELL AS THE
CERTIFIER LISTED, HAS THE AUTHORITY TO AMEND THE CAUSE OF DEATH AT ANY
TIME, SHOULD THAT BE NECESSARY. THIS IS IMPORTANT IF THE ATTENDING
PHYSICIAN IS UNAVAILABLE TO SIGN THE ORIGINAL RECORD AND AN ASSOCIATE
OR COVERING PHYSICIAN IS ACTING AS CERTIFIER.

36a. CERTIFIER’S MAILING – STATE

Enter the state where the certifier receives mail.

36b. CITY OR TOWN

Enter the city or town where the certifier receives mail.

36c. STREET ADDRESS

Enter the street address of the certifier.

36d. ZIP CODE

Enter the zip code of the address listed in item 35c.

THESE ARE LEGAL ITEMS ATTESTING THAT THE FACTS CONCERNING THE DEATH
ARE CORRECT. THEY IDENTIFY THE PERSON WHO COMPLETED THE MEDICAL
PORTION OF THE CERTIFICATE. THE ADDRESS OF THE CERTIFIER IS NEEDED TO
OBTAIN ADDITIONAL INFORMATION CONCERNING THE DECEDENT.

37. SUBREGISTRAR - Signature and Date

The subregistrar within the funeral establishment should sign and date this item after a
careful review of the record for completeness and to verify that the cause of death does not
need to be reported to the medical examiner's office.

If the funeral establishment does not have a subregistrar, leave this item blank.

38a. LOCAL REGISTRAR - Signature




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The registrar signs the certificate when it is registered and accepted in the local vital
statistics office.

38b. DATE FILED BY REGISTRAR (Month, Day, Year)

This item will be completed by the local, deputy, or state registrar when the certificate is
received. The date entered should be the actual date the record was received in the county
vital statistics office.

THE LOCAL REGISTRAR SIGNATURE DOCUMENTS THE FACT THAT THE
CERTIFICATE WAS REGISTERED WITH AND ACCEPTED BY THE REGISTRAR. THE
DATE DOCUMENTS WHETHER THE DEATH CERTIFICATE WAS REGISTERED WITHIN
THE TIME PERIOD SPECIFIED BY LAW.


                                   MEDICAL SECTION OF RECORD

These items comprise what is commonly known as the “medical portion” of the death
certificate and generally come under the jurisdiction of the certifying physician/medical
examiner. The cause of death should be the physician’s best medical opinion. Terms such
as “possible”, “probable”, etc. can be used when the certifier is not comfortable making an
exact diagnosis. Death records can be amended at any time should additional information
become available.

39. PROBABLE MANNER OF DEATH

Check the appropriate line. The manner of death should be completed by the certifying
physician or medical examiner only.

If the "Manner of Death" is stated to be Natural, that box should be checked.

If manner indicates Accident, Suicide, Homicide, Pending Investigation, or Undetermined,
the case automatically comes under the jurisdiction of the medical examiner and, as such,
the medical examiner must be notified. The ME must be notified in all of theses instances.

40. REPORTED TO MEDICAL EXAMINER DUE TO CAUSE OF DEATH? Yes or No

This item must be completed on all records. If the cause of death does not require medical
examiner notification, the item should indicate “No.”

Whenever a case is reported to the medical examiner due to the cause of death, whether
jurisdiction is accepted or declined, the entry in this item should indicate, "Yes." This would
include reporting cases for trauma (accident, suicide, homicide, or undetermined) and
unattended deaths as stated in s. 406.11, F.S.

If the cause of death indicates trauma or contains one of the key words outlined in
“Reviewing Medical Certification on Death Certificates” as shown later in this chapter, and it
has not been certified by the district medical examiner, the subregistrar should contact the
medical examiner immediately and inform him/her of the case.




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The funeral director/subregistrar or local registrar who notifies the medical examiner should
strike through the word No in item 40, indicate "Yes,” and initial. Please note that we are not
advising you to contact the attending physician who certified the record nor question, in any
way, the physician's clinical diagnosis for cause of death.

IT IS IMPORTANT THAT ALL CASES FALLING UNDER THE MEDICAL EXAMINER’S
JURISDICTION ARE REPORTED PROMPTLY. THIS ALLOWS FOR PROPER
INVESTIGATION FOR LEGAL AS WELL AS CIVIL MATTERS.

41. CAUSE OF DEATH

This section for cause of death has two parts:
       Part I. Immediate cause of death and antecedent causes. In Part I, the immediate
       cause of death is to be listed first, meaning the disease, injury, or complication
       causing death.

              Part I is further divided into:
              a) Immediate cause_________________________
                 Due to
              b) Intervening underlying or antecedent cause____
                 Due to
              c) Underlying or intervening antecedent cause____
                 Due to:
              d) Underlying cause_________________________

There may be no intervening or underlying cause(s) associated with the immediate cause
(i.e. the immediate cause is also the underlying cause) or there may be none or one or more
intervening cause(s) between the immediate cause and the underlying cause; in any case
the underlying cause (the disease or condition that initiated a chain of events that ultimately
resulted in death) should be the last entry in Part I. If final diagnosis is not made, entries
indicating determination of cause of death pending investigation or unknown are acceptable.
However, Dead on Arrival (DOA) is not acceptable.
         Part II. Other significant conditions. Part II of the cause of death section is for other
         significant conditions contributing to the death but not resulting in the underlying
         cause given in Part I. If trauma is mentioned either in Part I or Part II, items 46 - 52,
         the injury related items, should be completed.

The cause of death should be the physician’s best medical opinion. Terms such as
“possible”, “probable”, etc. can be used when the certifier is not comfortable making an
exact diagnosis. Death records can be amended at any time should additional information
become available.

THIS IS THE MOST IMPORTANT STATISTICAL AND RESEARCH ITEM ON THE DEATH
CERTIFICATE. IT PROVIDES MEDICAL INFORMATION THAT SERVES AS A BASIS
FOR DESCRIBING TRENDS IN MORTALITY AND FOR ANALYZING THE CONDITION
LEADING TO DEATH. IT ALSO SERVES THE FAMILY IN PERSONAL AND LEGAL
MATTERS

AN AUTOPSY IS IMPORTANT IN GIVING ADDITIONAL INSIGHT INTO THE
CONDITIONS THAT LEAD TO DEATH. THIS ADDITIONAL INFORMATION IS



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PARTICULARLY IMPORTANT IN ARRIVING AT THE IMMEDIATE AND UNDERLYING
CAUSES IN VIOLENT DEATHS.


         REVIEWING MEDICAL CERTIFICATION ON DEATH CERTIFICATES

When reviewing death certificates to determine acceptability for registering, an important
task of the subregistrar is to examine the medical certification section to determine if a
case falls within the jurisdiction of the medical examiner and should, therefore, be reviewed
and signed by him/her. Cases where the medical examiner would have a concern include
deaths that involve:
    1. An act of criminal violence
    2. An accident
    3. Homicide
    4. Suicide
    5. Sudden death (includes sudden infant death syndrome or SIDS)
    6. Criminal abortion
    7. Poison
    8. Death while in an institution or police custody
    9. Disease that constitutes a thereat to public health
    10. Disease , injury, or toxic agent that results from employment
    11. Any other unusual circumstances
The medical examiner should be notified immediately if such cases are detected, or if there
is any doubt (s. 406.11 (1), F.S.).

Generally, causes of death that should be certified by the local medical examiner are easily
recognized. However, there may be cases where unusual circumstances are not clearly
indicated. In these cases, key words/buzzwords or phrases in the cause of death section
should be noted, such as:

abrasion                                   exsanguination                  overdose
accident                                   fall                            pulmonary emboli
bite                                       fracture                        puncture
bruise                                     hanging                         seizure disorder
burns (thermal)                            hematoma                        strangulation
concussion                                 hip nailing                     subarachnoid
contusion                                  hyperthermia                    hemorrhage
crushing                                   hypothermia                     suffocation
cut                                        injury                          trauma
drowning (near)                            laceration                      wound
electric shock                             MVA (motor vehicle
exposure                                   accident)




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These terms may suggest that a traumatic event occurred prior to death.

In the event that you receive a record with any of the causes listed above or which contains
one of these key words, and it has not been certified by the district medical examiner or item
40 has a "No" entry, the subregistrar should contact the medical examiner immediately and
inform him/her of the case. The funeral director/subregistrar or local registrar who notifies
the medical examiner should strike through the word No in item 40, indicate "Yes,” and
initial. Please note that we are not advising you to contact the attending physician who
certified the record nor question, in any way, the physician's clinical diagnosis for cause of
death.

Upon notification, the medical examiner may wish to contact the attending physician for
more information and may decide to certify a new death certificate. This action should be
decided by the medical examiner. It is important that only one certificate is accepted for
permanent filing.

In the event the medical examiner does not take jurisdiction in such cases and items
46 - 52 have not been completed, the certificate must be returned to the attending physician
for completion of these items. The funeral director should not complete these items. If any
of the information is not available to the certifier, an entry of "Unknown" or "Not available"
will be acceptable in the designated item.

The funeral director/subregistrar should discuss these procedures with the district medical
examiner in an effort to see that all deaths that come within the jurisdiction of the medical
examiner are properly completed and certified by him/her as mandated by law.

42a. WAS AN AUTOPSY PERFORMED? Yes or No

Check "Yes" if a partial or complete autopsy was performed; otherwise, check "No."

42b. WERE AUTOPSY FINDINGS AVAILABLE TO COMPLETE THE CAUSE OF
DEATH? Yes or No

Check "Yes" if the autopsy findings were available to determine the cause of death.
Otherwise, check "No." If no autopsy was performed, leave this item blank.

43a. IF SURGERY IS MENTIONED IN PART I OR II, ENTER REASON FOR SURGERY

The physician certifying to the cause of death should complete this item with the appropriate
information. Enter the reason for the surgery not the type of surgery listed in Part I or Part II.

43b. DATE OF SURGERY (Month, Day, Year)

Enter the month, day, and year of the surgery. A written date entry is preferred over a
numerical entry.




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44. DID TOBACCO USE CONTRIBUTE TO DEATH?

In the certifier’s professional opinion, did the use of tobacco contribute to the decedent’s
death? Check the appropriate line.

TOBACCO IS A MAJOR PUBLIC HEALTH ISSUE AND FOR THAT REASON,
STATISTICAL DATA ON ITS USE AND RELATION TO CAUSE OF DEATH IS
IMPORTANT.

45. IF FEMALE (select one)

If deceased is male, no action is required and item 44 should be left blank.
       __ Not pregnant in past year
       __ Pregnant at time of death
       __ Pregnant: 1 to 42 days of death
       __ Pregnant: 43 days to 1 year of death
       __ Unknown if pregnant in past year
This item should be completed for all women of normal childbearing age.

46 – 52. INJURY RELATED ITEMS

The certifying physician/medical examiner must complete these items in cases where
trauma or injury is mentioned in cause of death. Deaths resulting from violence normally
are certified by a medical examiner. However, there may be instances in which an attending
physician may be certifying to an accidental death with the approval of the medical
examiner. In these cases, the attending physician is to complete items 46 - 52.

46. DATE OF INJURY (Month, Day, Year)

Enter the exact month, day, and year that the injury occurred. A written date entry for the
month is preferred rather than numerical.

47. TIME OF INJURY (24 hr.)

The physician should enter the exact time of injury in the 24-hour clock format. Enter
12 noon as "1200." One minute after 12 noon is entered as "1201." Enter 12 midnight or
midnight as "0000." One minute after 12 midnight is entered as "0001." Remember that
midnight is the beginning of the new day.

48. INJURY AT WORK? Yes or No

Check "Yes" if injury occurred while decedent was at work; if not, check "No." If this cannot
be determined, enter "Unknown."




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49a-e. LOCATION OF ACCIDENT OR INJURY

49a. LOCATION OF INJURY - STATE

Enter the name of the state where the injury occurred.

49b. CITY OR TOWN

Enter the city, town or location where the injury occurred.

49c. STREET ADDRESS

Enter the address where the described injury took place.

49d. APT. NO.

If the decedent lived in an apartment or other type multiunit building, enter the unit number.

49e. ZIP CODE

Enter the zip code of the address listed in item 35f.

50. DESCRIBE HOW INJURY OCCURRED

Briefly and clearly, describe how the injury occurred, such as "fell off ladder while painting
house."

51. PLACE OF INJURY (e.g. Decedent’s home, construction site, restaurant, wooded
area)

Enter the general category of the place where the injury occurred. Do not enter firm or
organization names, just the general category for the place of injury, such as loading
platform, office building, baseball field, etc.

52a-b. IF TRANSPORTATION INJURY

If the cause of death relates to a motor vehicle accident, additional information is required to
better classify cause of death.

52a. STATUS OF DECEDENT
2
Check the appropriate entry to indicate the status of the decedent – was he/she the driver, a
passenger, a pedestrian or “Other”?

52b. TYPE OF VEHICLE
Check the appropriate entry to indicate the type of vehicle that was involved in the accident
or, in the case of a pedestrian, the type of vehicle that struck him/her.

IN CASES OF ACCIDENTAL DEATH, THESE ITEMS ARE USED IN JUSTIFYING THE
PAYMENT OF DOUBLE INDEMNITY ON LIFE INSURANCE POLICIES. THEY ARE
NEEDED FOR A MORE ACCURATE DETERMINATION OF CAUSES OF DEATH. THESE


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ITEMS ALSO FORM THE BASIS OF STUDIES OF DATE AND TIME OF INJURY AND
OCCUPATIONAL INJURIES.




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                                     CHAPTER 6 – THE BURIAL-TRANSIT PERMIT



                    CHAPTER 6 – THE BURIAL TRANSIT PERMIT
GENERAL

The burial-transit permit (BTP) is the first notification to the vital statistics office that a death
has occurred. It is imperative that BTPs are filed on time with the vital statistics office and
that the CDR uses them to ensure compliance with death registration rules and guidelines.

Under state law, the completion of the BTP is the responsibility of the funeral director/direct
disposer or whoever first assumes custody of the body. He/she must obtain a permit within
five days or before final disposition of the decedent and it must be forwarded to the county
of death within 24 hours of issuance.

Most funeral establishments now have subregistrars among their staff who are authorized to
issue burial-transit permits. The funeral director must have the burial-transit permit in
his/her possession before final disposition of the decedent is authorized. When final
disposition is made within the state, the person in charge of the cemetery, crematory, or
other premises must endorse and send this permit to the local registrar of the county where
disposition is made. Burial-transit permits are retained by the local registrar for three years
from the date of filing, after that time they may be destroyed.

There is no extension of time for filing the burial-transit permit. It is permissible, however,
for the subregistrar to fax a copy of the permit to the CDR in order to meet the statutory
requirements for filing of the permit. It is not permissible to hold the permit until the death
certificate is signed unless you are filing both at the same time.

There is only one permit filed for each decedent, regardless of who handles the remains, if
they are transferred from one establishment to another, or if the medical examiner first has
custody and files the permit. If remains are disinterred at a later date and the original permit
is not available, a new permit cannot be issued.

The Disinterment/reinterment permit was repealed effective July 1, 1997. All other
statutory requirements for disinterring human remains are still in place. The repeal of the
disinterment/reinterment permit is the only thing that changed. It is suggested that the
funeral director type on funeral home letterhead stationery a statement indicating that the
form no longer exists and send the letter, accompanied by a certified copy of the death
certificate, along with the remains. The funeral director cannot complete another burial
transit permit for this purpose – remember, the BTP is for the “newly dead” and it’s only one
per customer.

The permit is a document completed in triplicate and entries must be legible on all three
copies:
   1. White original -- accompanies the decedent to the place of final disposition and is
        filed in the county of final disposition within 10 days after final disposition;
   2. Yellow copy – is the funeral director’s copy;
   3. Pink copy – must be filed with the county of death within 24 hours after issuance.

The burial-transit permit is a tracking form to ensure that a death certificate is filed for all
deaths that occur in Florida. Notations can and should be made to this form to update
information i.e., legal name now known vs. nickname shown; change of funeral home or
physician.


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      DETAILED INSTRUCTIONS FOR COMPLETING THE BURIAL-TRANSIT PERMIT

The permit is an official document and the information on the permit should be typewritten.
The following instructions and information will be helpful in filling out the BTP. The items are
numbered to conform to the Florida BTP.

PARTS A and B are the same for all three copies (white original, yellow, pink).

PART A – APPLICATION FOR BURIAL TRANSIT PERMIT
  1. Name of Deceased (First, Middle, Last)
     Type, or print legibly, the legal name of the deceased; space out the full first, middle
     and last names. Do not use titles such as General, Doctor, Father, etc. If the name
     is unknown at the time the permit is filed, enter “Unknown.” If the deceased is
     identified by the time the death certificate is completed, a notation can be made to
     the permit, indicating the change in name status.

         If the decedent is under 30 days old and the parents have not selected given names,
         enter the surname only. Do not enter "Baby Boy" or "Infant Girl."

         Date of Death (Month, Day, Year)
         Enter month, day, and year that death occurred. Enter the full or abbreviated name
         of the month (Jan., Feb., Mar. etc.). Do not use a number for the month. Pay
         particular attention to the entry of month, day, and year when the death occurs
         around midnight or December 31. Consider a death at midnight to have occurred at
         the beginning of the day rather than the end of the day.

       If the date of death is unknown, enter the date the body was discovered; the words
       "found on" should be entered above the date of death.
    2. Place of Death (County, City, Town or Location; Name of Hospital or
       Institution)
       Enter the county where death occurred, followed by the city, town or location of
       death. If decedent died in a hospital or other institution, enter the name of the
       facility. If death occurred somewhere other than a hospital or institution, give the
       street address for that location.
    3. Name of Medical Certifier (Medical Examiner or Physician -- Address and
       Phone Number)
       Check the box to indicate whether the certifier who has agreed to provide the
       medical certification of cause of death is the medical examiner or a private physician.
       Include the name, address and phone number of the medical examiner or physician.
    4. Name of Funeral Home/Direct Disposal Establishment (Address, Florida
       License Number/Registration Number, Phone Number)
       Indicate the name, address, telephone number and license number of the funeral
       home or direct disposal establishment applying for the permit.




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    5a-c. Check Appropriate Box (make one entry in 5a, b or c)
           5a.      A Complete Certificate of Death Accompanies this Application
                    This box is to be checked only when a completed death certificate,
                    including cause of death, accompanies the pink (LR) copy of the
                    permit when presented to the Local Registrar of the county of death.
                    If the completed death certificate cannot be obtained within the five
                    days allowed for filing the pink copy, 5b should be checked.
           5b.      Cause of Death from Natural Causes
                    Provide the name of the person contacted at the physician’s office
                    who provided assurance that the physician would complete and sign
                    the medical certification of death on the certificate and the date
                    he/she was contacted. This person must be either the physician or a
                    responsible person who can speak for the physician.

              When speaking with the physician or staff in his/her office there are three
              questions that should be asked.
                   1.) Will the physician sign the death certificate?
                   2.) Will the physician be available to sign the medical certification within 72
                       hours after presented by the funeral director?
                   3.) Is there any reason this death should be reported to the medical examiner
                       for investigation?
              It is imperative to verify this information and not accept information provided by
              law enforcement or someone else that might be on the scene that cannot speak
              for the physician.

           5b should be checked for deaths from natural causes and only those cases that
           do not fall under the medical examiner’s jurisdiction as outlined in s. 406.11 F.S.
           In those instances, 5c is the proper box to be checked, as indicated below.
           5c.          Medical Examiner Case
                        Check this box to indicate if it is a medical examiner case, as required
                        in s. 406.11, F.S. Give the name of the person who verified that the
                        medical examiner will complete and sign the medical certification of
                        death on the certificate and the date the contact was made.
    6. Funeral director/direct disposer (Signature, F.E. No./Reg. No., Date Signed)
       Requires the signature of applicant funeral director, FE license number or direct
       disposer, registration number and the date the application was signed. If the funeral
       director is also a subregistrar, the funeral director cannot issue a permit to
       himself/herself. The date signed cannot be after the date the permit is issued.


PART B – BURIAL TRANSIT PERMIT – Permission is hereby granted to dispose of this
body.

Section 382.006, F.S. requires that a burial transit permit be obtained prior to disposition or
removal from the state and within five days after death. It shall be mailed or delivered to the
local registrar in the county where death occurred within 24 hours after issuance as required
in Chapter 64V-1.011, F.A.C. The permit can be faxed to the county vital statistics office. It
is not necessary to wait until the funeral director/direct disposer has custody of the actual
body to begin the paperwork.




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A subregistrar may issue a burial-transit permit to any licensed Florida funeral director, other
than himself/herself. The registrar or subregistrar who issues the permit will sign and date
the Permit Application on the date issued and assign the permit number. Detailed
instructions on assigning the permit number follows below.

1. Assigning the Burial-Transit Permit Number
   Burial-transit permits must be numbered in consecutive order, prefaced by the year and
   the funeral establishment license number/ direct disposal establishment registration
   number. For example, the first permit issued at a funeral establishment with license
   number 250 would be 2009-250-1, OR 09-250-1.

    A subregistrar may not be commissioned at more than one establishment; however, if
    they work at more than one establishment or issue to an establishment other than
    his/her own, the permit number can be the next sequential number of that second
    establishment.

    Local registrars may also issue burial-transit permits for those deaths that occur in their
    county only. When issuing a permit, the registrar must:
       a. Issue the permit; the permit number should be the next sequential number of the
           requesting establishment;
       b. Grant an extension of time if so requested;
       c. File the pink copy in the county office (the yellow copy is the funeral director’s
           copy and the white original accompanies the body);
       d. Local registrars do not have an obligation to issue burial-transit permits outside of
           regular office hours.

2. Checkboxes and time limits for filing death certificate
   A completed death certificate should accompany the application for the permit unless
   completion of the death certificate within the five-day time period for filing is not possible.
   In this case, the funeral director/direct disposer may request a five business day
   extension of time.

    Before checking the appropriate box, the funeral director must personally:
           a. Contact the attending physician and obtain his/ her assurance that the death
              was from natural causes and that he/she will certify to the cause of death; OR
           b. If the death falls within jurisdiction of the medical examiner, item 5c of the
              application must be checked.

                   A five-day extension of time is requested …
                   An extension of time, as stated in s. 382.008 (3)(a), F.S., can be granted by
                   the subregistrar or local registrar issuing the permit. [This extension allows
                   for an additional five business days.]
                   No extension of time for filing the death certificate has been requested -
                   If no additional time is needed, this box should be checked.




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Request for Additional Time beyond five-day extension
   If the funeral director requests additional time beyond the five-day extension, the request
   must be made in writing, stating the need for the additional time, to the vital statistics
   office in the county where death occurred only under the following conditions:
            a. The physician will sign the death certificate but will be unavailable until after
                the normal registration time; or
            b. The physician changes his or her mind and refuses to sign the death
                certificate.
   The Death Registration Delay Report (DRD), DH 1355, is the mechanism by which this
   additional time is requested. The DRD must be submitted by the funeral director/direct
   disposer to the local registrar, detailing his or her efforts to complete the record if it
   cannot be submitted within the statutory time limits. Additional information on the DRD
   report can be found in Chapter 4 of this handbook.

3. Registrar or Subregistrar Signature -- Whoever issues the permit must sign here.

4. Date Issued -- The burial transit permit must be obtained within five days of the date of
   death. The permit must be filed with the county vital statistics office within 24 hours of
   issuance as specified in chapter 64V-1.011, F.A.C.

5. Date Certificate Due
   The date the death certificate is due is calculated based on the date of death and
   whether or not an extension of time is requested. Whoever issues the permit is
   responsible for completing this item on the permit.
          a. If no extension of time is requested, the death record is due five calendar
              days after death, with day one starting on the day after death. This includes
              weekends and holidays
          b. If an extension of time is requested, an additional five business days are
              allowed for filing. This excludes weekends and holidays.
          c. In other words, the first five days are consecutive; the second five days do
              not include the weekend or any holiday. It is important to calculate this date
              correctly since it is the basis for any noncompliance issue that may occur.


PART C – AUTHORIZATION for CREMATION, DISSECTION or BURIAL AT SEA
(cemetery or crematory, white original; funeral director/direct disposer, yellow copy)

Approval for cremation, dissection, or burial at sea must be authorized by the medical
examiner in the district where the death occurred. The funeral director/direct disposer
should contact each medical examiner office for their procedures.

Space is provided for the Approval Number, the date approval was granted and the person
in the medical examiner’s office who provided the information. In addition, the person
obtaining the approval should provide their name and the date such approval was obtained.

For cremation, a waiting period of 48 hours after death must be observed and medical
examiner approval obtained.


PART C – FOR LOCAL REGISTRAR USE ONLY (Pink copy)



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                                     CHAPTER 6 – THE BURIAL-TRANSIT PERMIT



The BTP is utilized by the CDR to track deaths that occur in the county and ensure that all
death certificates are filed on time. The permit is an important part of the documentation
utilized in noncompliance issues.

Notations may be made on the LR (pink) copy of the permit. The CDR can update the name
of the decedent; change the physician who is to provide medical certification or change the
name of the funeral home, etc.

It is permissible to fax a copy of the permit to the CDR.


PART D – CEMETERY OR CREMATORY

The white original of the permit travels with the body. The sexton or person in charge
(funeral director/direct disposer when there is no sexton) should sign and indicate the date
and place of disposition.

The appropriate box should be checked to indicate the Method of Disposition. If “Other” is
checked, specify the place of final disposition.

                   Burial
                   Cremation
                   Storage
                   Other (Specify)

The white copy must be signed and returned to the county where disposition takes place
within 10 days of final disposition as required in s. 382.007, F.S.

PART D – FOR FUNERAL DIRECTOR/DIRECT DISPOSER USE ONLY

The yellow copy of the permit is for funeral director/direct disposer use and should be
completed as follows:
   1. Date Burial-Transit Permit (pink copy) was filed with Local Registrar
       This is the date the pink (LR) copy of the permit was filed with the local registrar in
       the county where death occurred. It is permissible to fax a copy of the permit if
       necessary. Contact the Chief Deputy Registrar if such arrangements need to be
       made. The pink copy is due in the county office within 24 hours of issuance.
   2. Date Temporary Certificate was filed with Local Registrar
       If a temporary (pending) death certificate was filed, enter the date filed with the local
       registrar in the county where death occurred.
   3. Date Permanent Certificate was filed with Local Registrar
       Enter the date the permanent (replacement) death certificate, with a completed and
       signed medical certification of cause of death, was filed with the local registrar in the
       county where death occurred.
   4. Follow-up Efforts and Activities (note parties and dates contacted)
       The funeral director/direct disposer should record any follow-up activity he/she made
       to obtain and file the death certificate. It is important that accurate documentation be
       kept.
   5. Name and Place of Disposition
       Enter the name, place and method of final disposition.


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    6. Death Registration Delay Report Filed
       The Death Registration Delay Report (DH 1355) is the written documentation
       required in statute when additional time beyond the five-day extension is needed. If
       there is difficulty in obtaining the medical certification, which causes the filing of the
       death certificate beyond the extension as indicated in Part B of the Burial-Transit
       Permit, this report should be filed with the local registrar in the county where death
       occurred.

         Indicate, “Yes” or “No” in the space provided. If “Yes,” enter the date filed.

         There is further explanation of the Death Registration Delay Report in Chapter 4 of
         this handbook.




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                                   CHAPTER 7 – REGISTRATION OF FETAL DEATHS



                CHAPTER 7 - REGISTRATION OF FETAL DEATHS

DEFINITION

Fetal death means death prior to the complete expulsion or extraction of a product of human
conception from its mother if the 20th week of gestation has been reached and the death is
indicated by the fact that after such expulsion or extraction the fetus does not breathe or
show any other evidence of life such as beating of the heart, pulsation of the umbilical cord,
or definite movement of voluntary muscles (s. 382.002 (7), F.S.).

A delivery meeting this description must be recorded on the current certificate of fetal death
prescribed by the department. If the exact period of gestation is unknown, the physician
uses his/her best estimation, which may be based upon fetus weight in grams, length of
fetus, or other factors. Specifically, the period of gestation for fetal deaths includes only that
period or estimated period, during which the fetus is alive in utero and does not include the
time between death of the fetus and later expulsion or delivery.

NOTE: If the newborn, regardless of gestational age, breathes or shows other evidence of
life (per the physician) after complete expulsion or extraction, even though it is only
momentary, the delivery must be registered as a live birth, a birth certificate must be
prepared, and the subsequent preparation of a death certificate is required. If an infant dies
at birth, the hospital should make it clear to whoever assumes custody of the remains
whether a fetal death certificate (DH 428) or a death certificate (DH 512) should be filed.

FETAL DEATH REGISTRATION (S. 382.008(1), F. S.)

Every fetal death of 20 or more weeks gestation shall be registered in the registration district
(county) in which delivery occurred. Fetal death records are to be registered within five
calendar days after such delivery with the local registrar of the county where delivery
occurred, and prior to final disposition or removal of the fetus from the state. If the delivery
occurs on a moving conveyance, the record is to be registered in the county in which the
fetus was first removed from such conveyance.

If a funeral director/direct disposer handles the fetal death, essentially the same procedures
are followed as in cases of other deaths. The funeral director/direct disposer who first
assumes custody of the remains shall register the fetal death record. In the absence of
such person, the physician or other person in attendance at or after the delivery is
responsible for registering the record.

In case of twins or other multiple fetal deaths, a separate record shall be prepared for each
fetus.

SIGNATURES REQUIRED

The certificate of fetal death is to be signed within seventy-two hours after being presented
to the physician in attendance. When inquiry is required by the medical examiner or when
fetal death occurs without medical attendance, the responsible official shall sign the medical
certification within 72 hours after taking charge of the case.




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A midwife may not sign the fetal death record. If the delivery is attended by a midwife, her
license number, name, and title should be entered in items 29a-c. A Certified Nurse Midwife
(CNM), by statute, works under the direction of a physician. If the delivery is by a CNM, that
physician would sign in item 26 and certify the cause of death. The CNM’s license number,
name, and title should be entered in items 29a-c. A Licensed Midwife (LM) works
independently of a physician. If the delivery is by a LM and there has been no physician in
attendance in the past 30 days, the cause of death must be certified by the medical
examiner as an unattended death, pursuant to s. 382.011, F.S. The LM’s license number,
name, and title should be entered in items 29a-c.

If someone other than a physician or midwife attends the delivery, that person’s name
should be entered in item 29b. Other (Specify) should be checked in item 29c and father,
grandmother, paramedic, cab driver, etc. should be entered, depending on the status of the
attendant.

The funeral director/direct disposer will indicate final disposition, sign the record and file with
the county vital statistics office. If applicable, the subregistrar will also sign and date the
record.

RESPONSIBILITY IN FETAL DEATH REGISTRATION

The physician's primary responsibility in the case of fetal death is to complete and sign the
cause of death section and enter the date of delivery. The physician will determine if the
delivery is a fetal death or live birth should there be any question; make the record available,
within 72 hours of receipt, to the funeral director/direct disposer in charge of the fetus so that
the record may be completed and registered within the prescribed time; and to cooperate
with the local and state registrars by replying promptly to queries regarding any item on the
certificate.

The funeral director/direct disposer’s responsibility in fetal death registration is essentially
the same as in death registration. The same is true of the manager of cemeteries,
crematoriums, or other premises where final disposition are made.

The hospital administrator, midwife, or physician is responsible for furnishing the required
medical data, items 36-55, within 72 hours of delivery to the funeral director in charge of the
arrangements. If the hospital makes final disposition, they must also comply with
registration requirements. They must obtain a burial transit permit from the CDR and obtain
medical examiner approval before final disposition.

If a midwife is in attendance at a delivery that results in a fetal death, she is required to
report that fetal death to the medical examiner as outlined in s. 467.019, F.S.

DISPOSITION OF THE FETUS

After the proper record has been submitted for registration and a permit obtained, the fetus
may be disposed of in accordance with the wishes of the family. If the remains are taken
charge of by a funeral director/direct disposer, the required information, together with names
and addresses, must be shown on the certificate.

If the hospital makes final disposition, they must prepare and register the fetal death
certificate, obtain the permit, notify the medical examiner, and follow all laws and rules


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                                   CHAPTER 7 – REGISTRATION OF FETAL DEATHS



regarding disposition as provided in chapter 470, F.S. If the remains are to be used in
medical study and/or cremated at a later date, the hospital must notify the medical examiner
as provided in chapter 406.11 (1) (c), F.S. Items 23a-b of the fetal death certificate must
show “Hospital Disposition,” the name of the hospital, and its location should be entered in
items 21 and 22a-b. The chief of staff, head of pathology department, or other appropriate
hospital official will act as “funeral director” and must sign the permit in item 6 and the fetal
death record in item 18b. Both the completed permit and fetal death record must be sent to
the local registrar within the statutory timeframe.

CONFIDENTIALITY

All information relating to cause of death, parentage, marital status, and medical information
is confidential and exempt from s. 119.07(1), F.S.




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                           CHAPTER 8 – PREPARING THE CERTIFICATE OF FETAL DEATH



   CHAPTER 8 – PREPARING THE CERTIFICATE OF FETAL DEATH
Fetal death certificates are to be completed and submitted for registration by either the
funeral director who assumes custody of the fetus or the hospital if fetal disposition occurs
therein. An explanation of the individual items of information to be entered on the fetal
death certificate follows. All items are to be completed.

If the 20th week of gestation has not been reached, do not prepare a fetal death
certificate; it is a non-recordable event.

           DEMOGRAPHIC PORTION OF THE FETAL DEATH CERTIFICATE

1. FETUS - NAME (First, Middle, Last)

Enter and space out the full first, middle, and last names of the fetus. Do not abbreviate.
Entries of Jr., II, etc., following the last name are acceptable. If the parents do not have
given names selected for the fetus, enter the last name only. DO NOT enter "baby girl" or
"infant boy."

For a fetus born to a married mother, the fetus shall have the surname of choice of the
mother and father listed on the fetal death certificate. In the absence of the listed father, the
mother may select the surname of the fetus.

If the mother is unmarried, she shall select the surname of the fetus.

THIS ITEM IS USED TO IDENTIFY THE FETUS FOR WHOM THE CERTIFICATE IS
BEING PREPARED.

2. DATE OF DELIVERY (Month, Day, Year)

Enter the exact month, day, and year that the fetus was delivered. Enter the full or
abbreviated name of the month (Jan., Feb., Mar., etc.). Do not use a number to designate
the month. Pay particular attention to the entry of month, day, and year when the delivery
occurs around midnight or December 31. Consider a delivery at midnight to have occurred
at the beginning of the day rather than the end of the previous day.

THIS ITEM IS USED TOGETHER WITH DATE OF LAST NORMAL MENSES TO
CALCULATE LENGTH OF GESTATION. IT IS ALSO USED FOR HEALTH STATISTICS
AND RESEARCH STUDIES.

3. SEX OF FETUS

Enter male, female, or undetermined. Do not abbreviate or use other symbols. Do not
leave this item blank.

THIS ITEM IS USED TO MEASURE FETAL AND PERINATAL MORTALITY BY SEX.




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4. WEIGHT OF FETUS (Enter lbs/ozs OR grams; grams preferred)

Enter the weight as shown in the hospital record, in either pounds and ounces or gram
(grams preferred), as shown on the scales used. Do not convert from one measure to the
other. There should be no fractions or decimals – round to the nearest whole number. E.G.
If 6 lbs 4 ½ oz, round up to 6 lbs 5 oz; if 7 lbs 3.3 oz, round down to 7 lbs 3 oz.

THIS IS THE SINGLE MOST IMPORTANT CHARACTERISTIC ASSOCIATED WITH
VIABILITY OF THE FETUS. IT IS ALSO RELATED TO PRENATAL CARE,
SOCIOECONOMIC STATUS, LEGITIMACY AND OTHER FACTORS SURROUNDING THE
DELIVERY AND CONSEQUENTLY, IS USED WITH OTHER INFORMATION TO PLAN
FOR AND EVALUATE THE EFFECTIVENESS OF HEALTH CARE.

5. TIME OF DELIVERY (24 hr)

Time of Delivery should be recorded in the 24 hour clock format. Enter the exact time the
fetus was delivered, according to local time. If daylight savings time is the official prevailing
time when delivery occurs, it should be used to record the time of delivery. Enter 12 noon
as "1200". One minute after 12 noon is entered as 1201. Enter 12 midnight as 0000; the
last hour of the day is 2359. One minute after 12 midnight is entered as 0001. Remember
that midnight is the beginning of the new day.

In cases of plural births, the exact time each fetus is delivered should be recorded as the
hour and minute of delivery for that fetus.

If time of delivery is not known, enter “Unknown”.

THIS ITEM DOCUMENTS THE EXACT TIME OF DELIVERY FOR VARIOUS USES.

6. COUNTY OF DELIVERY

Enter the name of the county where the delivery occurred. For deliveries occurring on a
moving conveyance, enter the county where the fetus was first removed from the
conveyance.

7. FACILITY NAME (If not institution, give street and number)

Enter the name of the facility where delivery occurred. When delivery occurs in a mental
hospital or penal institution; enter the street address of the facility and put a note on the
back of the record in the bottom margin, indicating the name of the facility/institution. If the
delivery occurred on a moving conveyance en route to or on arrival at a facility, the name of
the facility should be entered.

If the delivery occurred at home, enter the house number and street name of the place
where delivery occurred. If the delivery occurred at some place other than those described
above, enter the number and street name of the location. If there is no street address, give
best geographical description of the place that will assist in identifying the exact location.

If delivery occurred on a moving conveyance other than en route to a facility, enter as the
place of delivery the address where the fetus was first removed from the conveyance.



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Non-hospital deliveries: If the delivery occurred at home, enter the house number and street
name of the place where delivery occurred. If the delivery occurred at some place other
than those described above, enter the number and street name of the place of delivery. If
the delivery occurred on a moving conveyance other than en route to a hospital, enter as the
place of delivery the address where the fetus was first removed from the conveyance.

8. CITY, TOWN, OR LOCATION OF DELIVERY

Enter the name of the city, town, or location where the delivery occurred. For deliveries
occurring on a moving conveyance, enter city, town, or location where the fetus was first
removed from the conveyance.

If a fetus is found in this state and the place of fetal death is unknown, the fetal death should
be registered in this state. The place where the fetus was found should be considered the
place of fetal death.

9. PLACE WHERE DELIVERY OCCURRED (Check one)

Mark the line that applies to the type of place where the delivery occurred. A birthing center
located in and operated by a hospital is considered part of the hospital and should be
reported as occurring in the hospital. Freestanding birthing centers include those facilities
that are operated independently from hospitals. The "clinic/doctor's office" category includes
other non-hospital outpatient facilities where births usually occur.

If the delivery occurs in a penal institution, check “Other (Specify) and enter Public Building.

For “EN ROUTE” deliveries, “Other (Specify)” should be checked and enter the phrase “en
route.” Any other related information should be entered on the back of the record in the
bottom margin, e.g. father delivered fetus in car on way to hospital.

Indicate if this was a home delivery and if it was a planned or unplanned delivery at home.

THIS ITEM IDENTIFIES HOME DELIVERIES, DELIVERIES IN FREESTANDING
BIRTHING CENTERS, AND DELIVERIES IN NONHOSPITAL CLINICS OR PHYSICIANS'
OFFICES. SUCH INFORMATION PERMITS ANALYSIS OF THE NUMBER AND
CHARACTERISTICS OF DELIVERIES BY TYPE OF FACILITY AND IS HELPFUL IN
DETERMINING THE LEVEL OF UTILIZATION AND CHARACTERISTICS OF DELIVERIES
OCCURRING IN SUCH FACILITIES

10a. MOTHER's MAIDEN NAME (First, Middle, Last)

Enter the first, middle, and maiden last names of the mother.




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10b. MOTHER'S CURRENT SURNAME (if different than 10a)

Enter the current surname of the mother if different from that entered in 14a. If child is either
a foundling or an abandoned baby, enter “Unknown.”

THESE ITEMS ARE DOCUMENTARY EVIDENCE OF PARENTAGE. THE MOTHER'S
MAIDEN NAME IS AN IMPORTANT PART OF AN INDEX. IT IS ESPECIALLY USEFUL
SINCE THE MAIDEN NAME REMAINS CONSTANT, EVEN THOUGH THE LAST NAME
OF THE INDIVIDUAL BEING REGISTERED AND THE MOTHER'S MARRIED NAME MAY
CHANGE SEVERAL TIMES.

11. IS MOTHER MARRIED?

Enter "Yes" if the mother is married at the time of delivery. Otherwise, enter "No".
Remember, a woman is married even if she is legally separated.

THIS INFORMATION IS NEEDED TO STUDY THE SOCIAL PROBLEMS RELATED TO
OUT-OF-WEDLOCK DELIVERIES. IT IS EVEN MORE IMPORTANT AS A TOOL IN
STUDYING HEALTH PROBLEMS OF THE MOTHERS; FOR EXAMPLE, WHETHER
LOWER BIRTH WEIGHT, HAS A HIGHER INFANT MORTALITY, OR ARE BORN TO
MOTHERS WITH LESS PRENATAL CARE.

12. MOTHER’S DATE OF BIRTH (Month, Day, Year)

Enter the exact month, day, and year that the mother was born. Enter the full or abbreviated
name of the month. Do not use a number to designate the month.

THIS ITEM IS USED TO CALCULATE THE AGE OF THE MOTHER, WHICH IS ONE OF
THE MOST IMPORTANT FACTORS IN THE STUDY OF CHILDBEARING AND
CONSEQUENTLY IS WIDELY USED IN DEVELOPING STATISTICAL DATA. FOR
EXAMPLE, STUDIES HAVE BEEN DONE TO SHOW THE RELATIONSHIP OF THE
HEALTH OF THE CHILD AND AGE OF THE MOTHER.

13. MOTHER’S BIRTHPLACE (State, territory or Foreign Country)

If the mother was born in the United States, enter the name of the state. If the mother was
born in a foreign country or a U.S. territory, enter the name of the country or territory. If the
mother was born in the United States, but the state is unknown, enter "Unknown.” If the
mother was been born in a foreign country, but the country is unknown, enter "Unknown." If
no information is available regarding place of birth, enter "Unknown.”

THIS ITEM IS USED WITH THE CENSUS DATA TO COMPARE CHILDBEARING OF
WOMEN WHO RESIDE IN THE STATE WHERE THEY WERE BORN WITH THAT OF
WOMEN WHO RESIDE IN A STATE OTHER THAN THEIR STATE OF BIRTH.




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14a-g. MOTHER'S RESIDENCE

Mother's residence is the place where she has set up housekeeping. This is not necessarily
the same as her "home state", "voting residence", "mailing address", or "legal residence".
Never enter a temporary residence such as one used during a visit, business trip, or a
vacation. Residence for a short time at the home of a relative, friend, or home for unwed
mothers for the purpose of awaiting the birth of a child is considered to be temporary and
should not be entered here. Place of residence during a tour of military duty or during
attendance at college is not considered as temporary and should be considered as place of
residence of mother for entry on the certificate.

Do not enter a Post Office Box as the mother’s residence. If the location has no number
and street name, enter the rural route number and box number, or a geographical
description of place that will aid in identifying the precise location

14a. MOTHER’S RESIDENCE - STATE

Enter the name of the state in which the mother resides. This may differ from the state used
in her mailing address.

14b. COUNTY

Enter the name of the county in which the mother resides.

14c. CITY, TOWN, OR LOCATION

Enter the name of the city, town, or location where the mother resides. This may differ from
the city, town, or location used in her mailing address.

14d. STREET AND NUMBER

Enter the house number and street name of the place where the mother resides. It is
important to include any street indicators, e.g., N., N.W., etc. (Example: 126 S.E. Broadway
Ct.). If this location has no number and/or street name, enter the rural route number or a
geographical description of the place that will aid in identifying the precise location. Never
enter a Post Office Box.

14e. APT.NO.

Enter the apartment number, if applicable, otherwise, leave blank.

14f. ZIP CODE

Enter the zip code that corresponds with the address in items 14a-d.

14g. INSIDE CITY LIMITS?

Enter "Yes" if the location entered in item 14d (Street and number) is within the city limits of
14c (City, Town, or Location). Otherwise, enter "No."




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MOST STATISTICS ON FETAL DEATHS ARE TABULATED BY PLACE OF RESIDENCE
OF THE MOTHER. THIS MAKES IT POSSIBLE TO COMPUTE FETAL DEATH RATES
BASED ON THE POPULATION RESIDING IN THE AREA. FETAL DEATHS BY PLACE OF
RESIDENCE OF THE MOTHER ARE USED TO PREPARE POPULATION ESTIMATES
AND PROJECTIONS. THESE DATA ARE USED IN PLANNING FOR EVALUATING
COMMUNITY SERVICES AND FACILITIES, INCLUDING MATERNAL AND CHILD
HEALTH PROGRAMS, SCHOOLS, ETC. PRIVATE BUSINESSES AND INDUSTRIES
ALSO USE THESE DATA FOR ESTIMATING DEMANDS FOR SERVICES.

15. FATHER's NAME (First, Middle, Last)

Enter the name of the father. If no father information is available, leave items 15-17 blank.

ITEM NEEDED FOR IDENTIFICATION AND AS DOCUMENTARY EVIDENCE OF
PARENTAGE.

16. FATHER’S DATE OF BIRTH (Month, Day, Year)

Enter the exact month, day, and year that the father was born. Do not use a number to
designate the month. Enter the full or abbreviated name of the month. Remember, a fetus
delivered at midnight is delivered at the beginning of the day. If no father information is
available, leave blank.

AGE IS USED IN THE STUDY OF CHILDBEARING AND HEALTH.

17. FATHER’S BIRTHPLACE (State Territory or Foreign Country)

If the father was born in the United States, enter the name of the state. If the father was
born in a foreign country or a U.S. territory, enter the name of the country or territory. If the
father was been born in the United States, but the state is unknown, enter "Unknown." If the
father was born in a foreign country, but the country is unknown, enter "Unknown." If no
information is available regarding place of birth, enter "Unknown." If no father information is
available, leave blank.

THIS IS A STATISTICAL ITEM USED WITH CENSUS DATA TO STUDY FETAL DEATHS
WHO’S FATHERS, AT THE TIME OF DELIVERY, RESIDED IN THE STATE WHERE THEY
WERE BORN AND CHILDREN WHO’S FATHERS RESIDED IN A STATE OTHER THAN
THEIR STATE OF BIRTH.

18a. LICENSE NUMBER (of Licensee)

Enter the personal state license number of the funeral service licensee (FD, FE, or KA). If
some other person who is not a licensed funeral director or direct disposer assumes custody
of the body, identify the person and in what capacity they are acting.




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18b. SIGNATURE OF FUNERAL SERVICE LICENSEE (or person acting as such)

This item is to be completed by the funeral director. If there is no funeral director involved,
have the person who assumes custody of the fetus sign the record, for example, pathologist
at hospital where fetus has been donated for scientific study.

19. NAME OF FUNERAL FACILITY

Enter the name of the facility handling the fetus prior to final disposition.

20a. FACILITY’S MAILING – STATE

Enter the complete mailing address of the facility handling the fetus prior to final disposition.

20b. CITY OR TOWN

Enter the city of the facility handling the fetus prior to final disposition.

20c. STREET ADDRESS

Enter the street address of the facility handling the fetus prior to final disposition.

20d. ZIP CODE

Enter the zip code of the facility handling the fetus prior to final disposition.

21. PLACE OF DISPOSITION (Name of cemetery, crematory, or other place)

Enter the name of the place of final disposition, such as “Oaklawn Cemetery” or “Hatcher
Cremations”, etc.

22a. LOCATION – STATE

Enter the state where the place of disposition is located.

22b. LOCATION – CITY OR TOWN

Enter the city or town where the place of disposition is located.

If the fetal remains are to be used for scientific or educational purposes, enter the name of
the city or town, where institution is located. If the hospital makes final disposition of the
remains, give the name of the city or town and where institution is located.




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23a. METHOD OF DISPOSITION

Check the box corresponding to the method of disposition of the fetal remains.
       __ Burial
       __ Entombment (Includes Mausoleum)
       __ Cremation
       __ Donation -- If the fetus is to be used by a hospital or a medical or mortuary
              school for scientific or educational purposes, enter "Donation" and specify the
              name and location of the institution in items 21 and 22a-b.
       __ Removal from State -- the term "Removal" is used when the remains are
              moved out of state.
       __ Hospital Disposition – If the family elects not to use the services of a funeral
              home and the hospital agrees to handle final disposition, this item should be
              checked. The hospital must notify the medical examiner before final
              disposition.
       __ Other (Specify) -- Specify the type of disposition
               (e.g., Storage, Burial-at-Sea, Calcination, etc.). If the fetal remains are to be
              buried at sea, enter in item 23b "Burial-at-Sea," item 21 should be completed
              with the name of the body of water (e.g., Atlantic Ocean), and item 22a-b
              should be completed with the county name (e.g., coast of Duval County,
              Florida).

If the funeral director knows that, after the remains are removed from state, cremation,
donation or burial at sea will be utilized, the funeral director should obtain the approval from
the medical examiner of the district in which the death occurred.

THESE ITEMS INDICATE WHETHER THE REMAINS WERE PROPERLY DISPOSED OF
AS REQUIRED BY LAW AND IS USED TO STUDY TRENDS AND DIFFERENCES IN
TYPES OF DISPOSITION.

23b. IF CREMATION, DONATION OR BURIAL AT SEA, WAS MEDICAL EXAMINER
APPROVAL GRANTED?

If final disposition was cremation, donation or burial at sea, has medical examiner approval
been granted? Answer Yes or No. This item should be in agreement with the entry shown
in 23a.

In the event you receive a record with any of the dispositions listed above and item 23b has
a "No" entry, the subregistrar should contact the medical examiner immediately, inform
him/her of the case, and receive the necessary approval. The funeral director/subregistrar
who notifies the medical examiner should strike through the word No in item 23b, indicate
"Yes,” and initial. If the chief or deputy registrar notes this discrepancy, they should proceed
as indicated, contact the medical examiner, make the change as indicated and file the
record.

Upon notification, before granting approval, the medical examiner may ask to see a copy of
the record; he/she may wish to contact the attending physician for more information and/or
may decide to certify a new fetal death certificate based on what is learned. This action




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should be decided by the medical examiner. It is important that only one certificate is
accepted for permanent filing.

THIS ITEM DIFFERENTIATES BETWEEN NOTIFYING THE MEDICAL EXAMINER BASED
ON FINAL DISPOSITION RATHER THAN FOR CAUSE OF DEATH AS SPECIFIED IN
ITEM 32. THESE ARE TWO ENTIRELY DIFFERENT PROCESSES.

24. CERTIFIER (check one)

         __        Certifying Physician – To the best of my knowledge, death occurred at the
                   time, date and place stated, and the fetus was born dead.
         __        Medical Examiner – On the basis of examination, and/or investigation, in my
                   opinion, death occurred at the time, date and place stated, and the fetus was
                   born dead.

Check the appropriate box. If the certifier is a private physician, check the box “Certifying
Physician.” If it is a medical examiner case, “Medical Examiner” should be checked. See
instructions for item 32 to determine if case falls under medical examiner jurisdiction.

25a. LICENSE NUMBER (of certifier)

Enter the license number of the physician certifying the medical certification of cause of
death.

25b. CERTIFIER’S NAME

Enter the name of the certifier.

25c. CERTIFIER’S TITLE

Indicate whether the certifier is an M.D. or a D.O.

26a. SIGNATURE OF CERTIFIER

The physician who certifies the cause of death signs the certificate.

26b. DATE SIGNED (mm/dd/yyyy)

Enter the numerical month, day, and year that the certifier signed the certificate.

27. MEDICAL EXAMINER’S CASE NUMBER

Case number is to be entered by medical examiner. If none is given, leave blank.

28a. CERTIFIER’S MAILING – STATE

Enter the state where the certifier receives mail.




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28b. CITY OR TOWN

Enter the city or town where the certifier receives mail.

28c. STREET ADDRESS

Enter the street address of the certifier.

28d. ZIP CODE

Enter the zip code of the address listed in item 28c.

THESE ARE LEGAL ITEMS ATTESTING THAT THE FACTS CONCERNING THE FETAL
DEATH ARE CORRECT. THEY IDENTIFY THE PERSON WHO COMPLETED THE
MEDICAL PORTION OF THE CERTIFICATE. THE ADDRESS OF THE CERTIFIER IS
NEEDED TO OBTAIN ADDITIONAL INFORMATION CONCERNING THE FETUS.

29a. LICENSE NUMBER (of Attendant)

29b. ATTENDANT’S NAME (if other than Certifier)

If the certifier is the attending physician, no entry is necessary. If the attendant was not a
physician, the name of the attendant is entered here, such as midwife, family member, or
other person.

29c. ATTENDANT’S TITLE

         __        C.N.M. – certified nurse midwife.
         __        L.M. – licensed midwife.
         __        Other. – someone other than a physician or midwife, such as family member,
                   friend, etc.

See Chapter 7 for detailed information on midwives and their role in fetal death registration.

IF THE DELIVERY IS ATTENDED BY A CERTIFIED MIDWIFE, THE DEATH MUST BE
CERTIFIED BY THE SUPERVISING PHYSICIAN. IF DELIVERY IS ATTENDED BY A
LICENSED MIDWIFE OR SOMEONE OTHER THAN A LICENSED PHYSICIAN, THE
DEATH MUST BE REPORTED TO THE MEDICAL EXAMINER.

30. SUBREGISTRAR - Signature and Date

The subregistrar within the funeral establishment should sign and date this item after a
careful review of the record for completeness and to verify that the cause of death does not
need to be reported to the medical examiner's office.

If the funeral establishment does not have a subregistrar, leave this item blank.




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31a. LOCAL REGISTRAR - Signature

The registrar signs the certificate when it is registered and accepted in the local vital
statistics office.

31b. DATE FILED BY REGISTRAR (Mo, Day, Year)

The local registrar will complete item 31b when the death certificate is received in the local
vital statistics office.

THE LOCAL REGISTRAR’S SIGNATURE DOCUMENTS THE FACT THAT THE
CERTIFICATE WAS REGISTERED WITH AND ACCEPTED BY THE REGISTRAR. THE
DATE DOCUMENTS WHETHER THE FETAL DEATH CERTIFICATE WAS REGISTERED
WITHIN THE TIME PERIOD SPECIFIED BY LAW.

32. REPORTED TO MEDICAL EXAMINER DUE TO CIRCUMSTANCES OF DEATH

Whenever a case is reported to the medical examiner due to the circumstances of death,
whether jurisdiction is accepted or declined, the entry in this item should indicate, "Yes."
This would include reporting cases for trauma, hospital disposition, or as unattended deaths
as stated in s. 406.11, F.S. If the case qualifies as one that should have been reported to
the medical examiner and it has not been certified by the district medical examiner, the
subregistrar should contact the medical examiner immediately and inform him/her of the
case.

The funeral director/subregistrar or local registrar who notifies the medical examiner should
strike through the word No in item 32, indicate "Yes,” and initial.

IT IS IMPORTANT THAT ALL CASES FALLING UNDER THE MEDICAL EXAMINER’S
JURISDICTION ARE REPORTED PROMPTLY. THIS ALLOWS FOR PROPER
INVESTIGATION FOR LEGAL AS WELL AS CIVIL MATTERS.

33. ESTIMATED TIME OF FETAL

         __        Before Labor
         __        During Labor
         __        During Delivery
         __        Unknown time of fetal death

Indicate when the fetus died by specifying one of the above choices.

THIS ITEM CAN BE AN IMPORTANT HEALTH INDICATOR WHEN DOING STUDIES ON
CAUSES OF FETAL DEATH.




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34a. WAS AN AUTOPSY PERFORMED?

Check "Yes" if a partial or complete autopsy was performed; otherwise, check "No." If
cause of death, item 35a indicates pending, item may be left blank.

34b. WAS A HISTOLOGICAL PLACENTAL EXAMINATION PERFORMED?

Check Yes if a histological placental exam was performed, otherwise, check No.

34c. WERE THE AUTOPSY OR HISTOLOGICAL PLACENTAL EXAMINATION
RESULTS USED IN DETERMINING THE CAUSE OF FETAL DEATH?

Check "Yes" if the autopsy or histological findings were available to determine the cause of
fetal death. Otherwise, check "No." If no autopsy or histological exam was done, leave this
item blank.

CAUSE/CONDITIONS CONTRIBUTING TO FETAL DEATH

These items are to be completed by the certifier:

35a INITIATING CAUSE OR CONDITION: Among the choices below, please select the
one cause or condition which most likely began the sequence of events resulting in
the death of the fetus.

         __        PENDING AUTOPSY OR HISTOLOGICAL RESULTS
         __        MATERNAL CONDITIONS/DISEASES (Specify)
         __        COMPLICATIONS OF PLACENTA, CORD, MEMBRANES
         __        OTHER OBSTETRICAL OR PREGNANCY COMPLICATIONS (Specify)
         __        FETAL ANOMALY (Specify)
         __        FETAL INJURY (Specify)
         __        FETAL INFECTION (Specify)
         __        OTHER FETAL CONDITIONS (Specify)

Check the one cause or condition that, in your opinion, is the initiating cause that most likely
began the sequence of events resulting in the death of the fetus. Be specific when listing
the choice. If there are other causes or conditions related to the fetal death, they should be
entered in item 35b.

Cause of fetal death should include information provided by the pathologist if an autopsy or
histological exam was done. If autopsy results or histological exams for a fetal death are
still pending at the time the report is filed, check “Pending”. Once results are complete, a
permanent or replacement record should be done, indicating the final cause.




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35b. OTHER SIGNIFICANT CAUSES OR CONDITIONS: Select or specify all other
causes or conditions contributing to the death of the fetus as stated in 35a.
List the fetal and/or maternal conditions, if any that contributed to the fetal death. Be
specific when listing your choices.

THIS ITEM PROVIDES MEDICAL INFORMATION FOR RANKING CAUSES OF FETAL
DEATH AND FOR ANALYZING THE CONDITIONS LEADING TO FETAL DEATH.
INFORMATION ON CAUSE OF FETAL DEATH IS CORRELATED WITH INFORMATION
FROM OTHER ITEMS ON THE REPORT, SUCH AS LENGTH OF GESTATION AND
PRENATAL CARE.


INFORMATION FOR MEDICAL AND HEALTH USE ONLY

This information must be furnished to the funeral director by the hospital administrator,
midwife, or physician within 72 hours after the fetal death occurs. The information for
medical and health studies are separated from the identifying information so that they can
be excluded from certified copies of the certificate. They are used for a wide range of
research and medical purposes.

Information obtained for this portion of the fetal death certificate should come from the
physician’s prenatal record for the mother, labor and delivery records, neonatal unit records
or other hospital medical records.

36 MOTHER’S RACE (Specify the race/races to indicate what mother considers
herself to be. More than one may be specified)

Check the race of the mother as obtained from the informant. Mark all entries that apply.
Complete “other, specify” as needed, e.g. Hispanic. If not known, enter Unknown after item
heading line. Do not leave this item blank.

THIS ITEM ALLOWS FOR MULTIPLE ENTRIES FOR “RACE” IN ORDER TO OBTAIN
MORE SPECIFIC INFORMATION. IT IS USED TO STUDY HEALTH CHARACTERISTICS
FOR RACIAL GROUPS (CHILDBEARING TRENDS, INFANT MORTALITY, BIRTH
WEIGHT, ETC.). RACE IS AN IMPORTANT VARIABLE IN PLANNING FOR AND
EVALUATING THE EFFECTIVENESS OF HEALTH PROGRAMS, AND IT IS ALSO USED
IN PREPARING POPULATION ESTIMATES.

37. MOTHER OF HISPANIC OR HAITIAN ORIGIN? (Specify if mother is of Hispanic or
Haitian Origin)

Check only one. Specify “Yes” or "No." If "Yes" is checked, indicate the appropriate choice`
as obtained from the parent(s) or other informant. Item 31 should be marked for the mother
on all certificates. The entry in this item should reflect the response of the informant. If
there is more than one, check Other Hispanic (Specify) and enter
Puerto Rican/Cuban or Mexican/Guatemalan, etc. If not known, enter Unknown after item
heading line. Do not leave this item blank.

For the purposes of this item, "Hispanic" refers to those people whose origins are from
Spain, Mexico, or the Spanish-speaking countries of Central or South America. Origin can



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be viewed as the ancestry, nationality, lineage, or country in which the person or his or her
ancestors were born before their arrival in the United States.

There is no set rule as to how many generations are to be taken into account in determining
Hispanic or Haitian origin. A person may report Hispanic or Haitian origin based on the
country of origin of a parent, grandparent, or some far-removed ancestor. The response
should reflect what the person considers himself or herself to be and is not based on
percentages of ancestry. Although the prompts include the major Hispanic groups of
Cuban, Mexican, and Puerto Rican, other Hispanic groups should also be identified in the
space provided.

This item is not a part of the Race item. A person of Hispanic origin may be of any race.
Each question, Race and Hispanic origin, should be asked independently.

HISPANICS COMPRISE THE LARGEST ETHNIC MINORITY IN THIS COUNTRY, AND IN
FLORIDA, HAITIANS ALSO COMPRISE A LARGE MINORITY. THIS ITEM PROVIDES
DATA TO MEASURE DIFFERENCES IN FERTILITY AND PREGNANCY OUTCOME AS
WELL AS VARIATIONS IN HEALTH CARE FOR PEOPLE OF HISPANIC, HAITIAN, AND
NON-HISPANIC OR HAITIAN ORIGIN. WITHOUT COLLECTION OF DATA ON PERSONS
OF THESE GROUPS, IT IS IMPOSSIBLE TO OBTAIN VALID DEMOGRAPHIC AND
HEALTH INFORMATION ON THIS IMPORTANT GROUP OF AMERICANS.

This item is not a part of the Race item. A person of Hispanic or Haitian origin may be of
any race. Each question, Race and Hispanic or Haitian origin, should be asked
independently.

38. MOTHER’S SOCIAL SECURITY NUMBER

Enter the social security number of the mother. If mother refuses to give her social security
numbers, complete this item with "Unknown" or "Unobtainable". If she does not have a
social security, enter “None.”

39. MOTHER’S EDUCATION (Specify mother highest degree of level of school
completed at time of delivery)

Mark the appropriate line that reflects the level of education of the mother. Count formal
schooling. Do not include beauty, barber, trade, business, technical, or other special
schools in this entry. If parent is from another country and has completed secondary
education, check “high school diploma or GED.”

EDUCATION IS CLOSELY RELATED TO FERTILITY, HEALTH PRACTICES, AND BIRTH
OUTCOME. IT IS ALSO USED AS AN INDICATOR OF SOCIOECONOMIC STATUS.




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40. DID MOTHER GET WIC FOOD FOR HERSELF DURING THIS PREGNANCY?

WIC is the Department of Agriculture’s nutrition program for Women, Infants and Children.
WIC provide pregnant women and/or their children formula, food, checks or vouchers for
food.

Check “No” if the mother did not get WIC food for herself during this pregnancy; check “Yes”
if she participated in the WIC program.

NUTRITION IS AN IMPORTANT FACTOR IN IMPROVING PREGNANCY OUTCOME FOR
BOTH MOTHER AND CHILD.

41. WAS MOTHER TRANSFERRED FOR MATERNAL OR FETAL INDICATIONS FOR
DELIVERY?

Check “No” if this is the first facility to which the mother was admitted for this delivery or if
delivery took place at home and mother came to the facility right after delivery. Check “Yes”
if the mother was transferred from one facility to another facility before the child was
delivered.

If the mother was transferred before the delivery, enter the name of the facility from which
she was transferred, e.g. mother started labor at freestanding birthing center, but was taken
to the hospital for the delivery. If the mother was transferred more than once, enter the
name of the last facility from which she was transferred.

THIS INFORMATION IS USED TO STUDY TRANSFER PATTERNS AND DETERMINE
WHETHER TIMELY IDENTIFICATION AND MOVEMENT OF HIGH-RISK PATIENT IS
OCCURRING.

42a-d. PRENATAL CARE

42a. PRENATAL CARE RECEIVED?

Check “Yes” or “No,” as appropriate. If no entry, leave items 42b-d blank.

42b. DATE OF FIRST PRENATAL VISIT (Mo, Day, Yr)

Enter the date of the first prenatal visit after becoming pregnant, when the mother first
received care from a physician or other health professional or attended a prenatal clinic, as
listed in the health care practitioner’s record.

If the exact day is unknown, but the month and year are known, obtain an estimate of the
day from the mother or her physician. If an estimate of the date cannot be obtained, enter
only the month and year. This date cannot be after the date of delivery.

THIS INFORMATION, IN CONJUNCTION WITH THE DATE OF LAST NORMAL MENSES,
PROVIDES DATA FOR THE MONTH THAT PRENATAL CARE BEGAN. THIS ITEM IS
NEEDED AS THE BASIS FOR MEASURES OF HOW SOON WOMEN INITIATE
PRENATAL CARE AND FOR MEASURES OF THE APPROPRIATE UTILIZATION OF
SERVICES.



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42c. DATE OF LAST PRENATAL VISIT (Mo, Day, Yr)

Enter the date of the mother’s last prenatal visit as recorded in the health care practitioner’s
record. If the exact day is unknown, but the month and year are known, obtain an estimate
of the day from the mother or her physician. If an estimate of the date cannot be obtained,
enter only the month and year.

THIS ITEM WILL ENSURE THAT ALL PRENATAL VISITS ARE COUNTED.

42d. PRENATAL VISITS

Enter the number of visits made for medical supervision from a physician or other health
care provider during the pregnancy.

THIS INFORMATION IS USED TO DETERMINE THE RELATIONSHIP OF PRENATAL
CARE TO THE HEALTH OF THE CHILD AT BIRTH.

43a-c. NUMBER OF PREVIOUS LIVE BIRTHS

43a. Number Now Living

Enter the number of prior children born alive to this mother who are still living at the time of
this delivery. Do not include this child or children by adoption. If this is the first pregnancy
for the mother, enter “0.” If not known, enter “Unknown” or “Unk.”

43b. Number Now Dead

Enter the number of prior children born alive to this mother who are no longer living at the
time of this delivery. Do not include this birth or any children by adoption. If this is the first
pregnancy for the mother, enter “0.” If not known, enter “Unknown” “Unk.”

43c. DATE OF LAST LIVE BIRTH (Month, Year)

Enter the date of birth (month and year) of the last live-born child of the mother. It is
preferred that the literal name of the month, in abbreviated form, be used.

If this certificate is for the second delivery of a twin set, enter the date of birth for the first
baby of the set, if it was born alive. Similarly, for triplets or multiple births, enter the date of
birth of the previous live birth of the set. If all previously delivered members of a multiple set
were fetal deaths, enter the date of the mother's last delivery that resulted in a live birth.

Enter "None" if mother has not had a previous live birth. If not known, enter “Unk.”




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44a. NUMBER OF OTHER PREGNANCY OUTCOMES (Spontaneous, induced losses,
or ectopic pregnancies)

Include each recognized loss of a product of conception such as miscarriage, fetal death,
and abortion (spontaneous and induced). Enter "0" if this is the first pregnancy for this
mother or if all previous pregnancies resulted in live-born infants. If not known, enter “Unk.”

If there is a twin pregnancy, and one twin dies prior to delivery and the second twin is
carried to term, this item should include the twin who died. Do not leave this item blank.

44b. DATE OF LAST OTHER OUTCOME (Month, Year)

Enter the date (month and year) of the last other outcome of pregnancy that was not a live
birth regardless of the length of gestation. It is preferred that the literal name of the month,
in abbreviated form, be used. If the mother has never had a termination, enter "None." If
not known, enter “Unk.” Do not leave this item blank.

If this certificate is for the second delivery of a twin set and the first was a fetal death, enter
the date of delivery of that fetal death. Similarly, for other multiple births, if any previous
member of the set was a fetal death, enter the date of delivery of that fetal death. If all
previously born members of a multiple set were live births, enter the date of the mother's last
delivery that resulted in a fetal death.

THESE ITEMS ARE USED TO DETERMINE LIVE BIRTH ORDER AND TOTAL BIRTH
ORDER THAT ARE IMPORTANT IN STUDYING TRENDS IN CHILDBEARING AND CHILD
SPACING. THEY ARE ALSO USEFUL IN STUDYING HEALTH PROBLEMS (e.g.,
HEALTH PROBLEMS ASSOCIATED WITH FIRST BIRTHS TO OLDER MOTHERS,
RELATIONSHIP OF INFANT MORTALITY TO BIRTH ORDER, ETC.).

THE DATES OF LAST LIVE BIRTH AND OTHER OUTCOMES ARE USED TO COMPUTE
THE INTERVALS BETWEEN LIVE BIRTHS AND FETAL DEATHS AND BETWEEN
PREGNANCIES IN STUDYING CHILD SPACING. THEY ARE ALSO IMPORTANT IN
DETERMINING WHETHER THERE ARE HEALTH PROBLEMS ASSOCIATED WITH
CLOSE SPACING OR WITH THE OUTCOME OF THE PREVIOUS PREGNANCY
(WHETHER OR NOT IT WAS A LIVE BIRTH).

45. TOBACCO USE DURING PREGNANCY?

Check "Yes" for tobacco use if the mother smoked tobacco at any time during the
pregnancy. Specify the average number of cigarettes the mother smoked per day during
her pregnancy. If the mother smoked but quit during the pregnancy, mark “Yes, but quit”;
specify the average number of cigarettes the mother smoked per day before she quit. If, on
the average, she smoked less than one cigarette per day, enter "Less than 1" (<1).

Place an "X" on the "No" line if the mother did not smoke during the entire pregnancy. Do
not make any entry on the line requesting the average number of cigarettes per day.

This information should be taken from the physician’s prenatal record for the mother.

46. MOTHER’S HEIGHT



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Enter mother’s height in feet and inches. Ideally, height should be measured without
shoes. Verify entries of 2-3 feet and 7-8 feet; put notation on back of record in bottom
margin indicating if correct. Do not enter inches only; for 66 inches, enter 5 ft. 6 in. There
should be no fractions or decimals, only whole number feet and inches. If 5 ft. 6 ½ in., enter
5 ft. 6 in; if 5 ft. ¼ in., enter 5 ft 0 in. If no inches, enter 5 ft. 0 in.

MOTHER’S HEIGHT, IN CONJUNCTION WITH PRE-PREGNANCY AND AT-DELIVERY
WEIGHT, CORRELATES WITH POSSIBLE OBESITY AND ITS EFFECT ON THE HEALTH
OF THE MOTHER AND A HEALTHY OUTCOME FOR THE CHILD.

47. MOTHER’S WEIGHT (in pounds)

Enter mother’s prepregnancy weight and weight delivery. Ideally, weight should be taken
without shoes. Enter “Unk” if the weight cannot be determined or is unknown for either item.
There should be no fractions or decimals, only a whole number. If 140 ½ lbs, enter 140 lbs;
if 150.3 lbs, enter 150 lbs.

MOTHER’S WEIGHT, PRE-PREGNANCY AND AT-DELIVERY, IN CONJUNCTION WITH
MOTHER’S HEIGHT, CORRELATES WITH POSSIBLE OBESITY AND ITS EFFECT ON
THE HEALTH OF THE MOTHER AND A HEALTHY OUTCOME FOR THE CHILD.

48. OBSTETRIC ESTIMATE OF GESTATION

Enter the number of completed weeks as estimated by the attendant. Do not compute this
information from the date last normal menses began and date of birth. If the attendant has
not done an obstetric estimate of gestation, enter "Not Done." Do not leave this item blank.

THIS ITEM PROVIDES INFORMATION ON GESTATIONAL AGE WHEN THE ITEM ON
DATE LAST NORMAL MENSES BEGAN CONTAINS INVALID OR MISSING
INFORMATION. FOR A RECORD WITH A PLAUSIBLE DATE LAST NORMAL MENSES
BEGAN, IT PROVIDES A CROSSCHECK WITH LENGTH OF GESTATION BASED ON
ULTRASOUND OR OTHER TECHNIQUES.

49. DATE LAST NORMAL MENSES BEGAN (Mo, Day, Yr)

Enter the exact date (month, day, and year), as obtained from the physician or hospital
record, of the beginning of the mother's last normal menstrual period. If the information is
unavailable from these sources, obtain it from the mother.

It is preferred that a written date entry, rather than numerical, be made.

If the exact day is unknown, but the month and year are known, obtain an estimate of the
day from the mother or her physician. If an estimate of the date cannot be obtained, enter
only the month and year.

If mother never has had a menses, enter “Never had menses.” Enter "Unknown" if the date
cannot be determined.

If the 20th week of gestation has not been reached, do not prepare a fetal death
certificate.



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THIS ITEM PROVIDES INFORMATION ON GESTATIONAL AGE WHEN THE ITEM ON
DATE LAST NORMAL MENSES BEGAN CONTAINS INVALID OR MISSING
INFORMATION. THIS MEASURE IS THE BASIS FOR REPORTING FETAL DEATHS IN
MANY STATES. FOR A RECORD WITH A PLAUSIBLE DATE LAST NORMAL MENSES
BEGAN, IT PROVIDES A CROSS-CHECK WITH LENGTH OF GESTATION BASED ON
ULTRASOUND OR OTHER TECHNIQUES.

50a-b. PLURALITY

When a multiple birth occurs, prepare and register a separate certificate for each child or
fetus. Register certificates relating to the same multiple birth set at the same time, unless
doing so will result in late filing.

In incidents where there is a twin pregnancy, and one twin dies prior to delivery and the
second twin is carried to term, the certificate should include the deceased twin in the
number of other outcomes (44a), and the date of last outcome (44b). Plurality (50a) should
indicate “twin.”

If this is a multiple birth, the birth registrar should verify if the pregnancy was a result of
infertility treatment. If the answer is “yes,” item 43, in “History Factors,” should be checked.

50a. PLURALITY (Single, twin, etc.)

Specify the delivery as single, twin, triplet, quadruplet, etc.

50b. IF NOT SINGLE BIRTH (Born first, second, etc.)

Specify the order in which the delivery being recorded was born - first, second, etc. If this is
a single delivery, leave the item blank. For multiple births still in the womb and for multiple
births that include a fetal death under 20 weeks gestation, make a note on the back of the
record.

THESE ITEMS ARE RELATED TO OTHER ITEMS ON THE CERTIFICATE THAT HAVE
BEEN SHOWN TO HAVE HEALTH IMPLICATIONS, ESPECIALLY BIRTH WEIGHT. THE
OCCURRENCE OF PLURAL BIRTHS IS RELATED TO THE AGE OF THE MOTHER AND
BIRTH ORDER OF THE CHILD.

51-55 CHECK ITEMS

The following medical and health items are formatted into lines to be checked. Please
review each item listed, and carefully check the appropriate line(s). Clearly mark an "X" or
check the line. The mark should not overlap more than one line. If the information is
unknown or unavailable, check “Other” and enter “Unknown”.

51. HISTORY FACTORS FOR THIS PREGNANCY (Check all that apply)

Check each of the medical history factors that the mother experienced during this
pregnancy. Complications should be entered even if they are a part of the cause of fetal
death in item 35. If the mother experienced medical history factor(s) not identified in the list
- for example, other infectious diseases, AIDS, or syphilis - check "Other" and enter the
history factor on the line provided. Medical history factors should be identified from the


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hospital or physician record. If there were no medical history factors, check "None." Do not
leave this item blank.

THIS INFORMATION ALLOWS FOR THE IDENTIFICATION OF SPECIFIC MATERNAL
CONDITIONS THAT ARE OFTEN PREDICTIVE OF POOR MATERNAL AND INFANT
OUTCOME. IT CAN BE USED FOR PLANNING INTERVENTION AND PREVENTION
STRATEGIES.

52. INFECTIONS PRESENT AND/OR TREATED DURING THIS PREGNANCY (Check all
that apply)

Mark all that apply.

ALL OF THE LISTED INFECTIONS ARE KNOWN TO CAUSE FETAL AND/OR
SUBSEQUENT NEONATAL INFECTION AND HAVE SIGNIFICANT PUBLIC HEALTH
IMPLICATIONS

53. METHOD OF DELIVERY (Complete all items A through E)

Complete all items A through E. This information should be obtained from the mother's
medical chart or the physician. If the information is unknown, enter Unknown after the
appropriate item.

Information should be consistent e.g.:
       Item A - if delivery with forceps was attempted and successful, item A must
       indicate No; item D should have Vaginal/Forceps checked;
       Item B - if vacuum delivery was attempted and successful, item B must indicate No;
       item D should have Vaginal/Vacuum checked;
       Item C - Vertex is the same as Cephalic;
       Item D – If Cesarean delivery, answer Yes or No to Was a trial of labor attempted

THIS INFORMATION IS USED TO RELATE METHOD OF DELIVERY WITH BIRTH
OUTCOME, TO MONITOR CHANGING TRENDS IN OBSTETRIC PRACTICE, AND TO
DETERMINE WHICH GROUPS OF WOMEN ARE MOST LIKELY TO HAVE CESAREAN
DELIVERY.

THE METHOD OF DELIVERY IS RELEVANT TO THE HEALTH OF MOTHERS,
ESPECIALLY IF IT IS BY CESAREAN SECTION. INFORMATION FROM THIS ITEM CAN
BE USED TO MONITOR DELIVERY TRENDS ACROSS THE UNITED STATES.




Vital Records Registration Handbook, 2008 Revision                                        126
                           CHAPTER 8 – PREPARING THE CERTIFICATE OF FETAL DEATH



54. MATERNAL MORBIDITY

Mark all that apply.

LABOR/DELIVERY COMPLICATIONS MAY AFFECT THE MOTHER’S ABILITY TO
BECOME PREGNANT IN THE FUTURE.

55. CONGENITAL ANOMALIES OF THE FETUS (Check all that apply)

Check each anomaly of the fetus. Do not include birth injuries. The checklist of anomalies
is grouped according to major body systems. If an anomaly is present that is not identified
in the list, check "Other" and specify the anomaly on the line provided. Note that each group
of system-related anomalies includes an "Other" category for anomalies related to that
particular system. If there is a question as to whether the anomaly is related to a specific
system, enter the description of the anomaly in "Other (Specify)" at the bottom of the list. If
there are no congenital anomalies of the fetus, check "None." This information should be
obtained from the medical chart or the physician. Do not leave this item blank.

INFORMATION ON CONGENITAL ANOMALIES IS USED TO IDENTIFY HEALTH
PROBLEMS THAT WOULD HAVE REQUIRED MEDICAL CARE HAD THE INFANT BEEN
BORN ALIVE. IT IS IMPORTANT FOR MONITORING THE INCIDENCE OF THESE
CONDITIONS AMONG ALL KNOWN PRODUCTS OF CONCEPTION. COLLECTION OF
THIS INFORMATION IS ALSO NECESSARY TO STUDY UNUSUAL CLUSTERS OF
SELECTED ANOMALIES AND TRACK TRENDS AMONG DIFFERENT SEGMENTS OF
THE POPULATION.




Vital Records Registration Handbook, 2008 Revision                                          127
                           CHAPTER 8 – PREPARING THE CERTIFICATE OF FETAL DEATH




Vital Records Registration Handbook, 2008 Revision                                128
                                                     GLOSSARY


 DEFINITION OF TERMS
The following definitions describe certain terms used in the manual:

Abandoned baby – a newborn infant abandoned at a fire station, emergency medical services
station or hospital within 7 days of birth, as outlined in s.383.50, F.S.

Administrative regulations - Rules prescribed by the Department of Health for the administration
of vital statistics laws.

Applicant - person requesting a copy of a vital record.

Attendant at birth - Any person in attendance at the time of a live birth or delivery of a dead
fetus.

Burial-transit Permit - A permit required before disposition of a dead human body or fetus can
be legally completed.

Certificate of Birth Resulting in Stillbirth – a certification for fetal deaths which can be issued upon
the parent’s request. This issuance comes from the state office only and there must already be a
fetal death certificate on file. The certification will not be considered as proof of a live birth, and
once issued, is no longer a confidential record.

Certificate of Death - The original of the standard Certificate of Death as prescribed by the
Department of Health.

Certificate of Fetal Death - The original of the standard Certificate of Fetal Death as prescribed
by the Department of Health.

Certificate of Live Birth - This is the original standard Certificate of Live Birth as prescribed by
the Department of Health.

Certificate received - A certificate arriving in the registrar's office by mail or delivered in person,
but not yet accepted for registration or filing. In this manual, the term "record" is
interchangeable with the term "certificate."

Chief Deputy Registrar - A person appointed by the state registrar, upon recommendation of the
local registrar, to act in the absence or disability of the local registrar.

Computer certification - A document produced by computer or other electromagnetic equipment
containing all or part of the exact information contained on the original vital record, and which,
when certified by the state registrar, has the full force and effect of the original vital record.

Cremate - To reduce to ashes by the action of fire.

Dead body - A lifeless human body or parts of such body, by the state of which it may
reasonably be concluded that death has occurred.

Death without medical attendance - A death occurring more than 30 days after the decedent
was last treated by a physician, except where death was medically expected as certified by an
attending physician.


Vital Records Registration Handbook, 2008 Revision                                                     129
                                                     GLOSSARY


Direct disposer - Any person who is registered in this state to practice direct disposition and is
responsible for the preparation and registration of certificates of death and fetal death.

Designated representative - The person appointed by the hospital administrator to certify birth
records from the hospital.

Disposition of fetal remains - The burial, interment, cremation, release for scientific study, or
other final disposal of a dead fetus.

Electronic Birth Registration (EBR) – the mechanism by which the hospital birth registrar registers
births through the Internet.

Filing of a record - Acceptance of a certificate by the local registrar. This term is synonymous
with registration.

Final disposition - The burial, cremation, or other disposition of a dead human body or fetus or
parts thereof.

Foundling – A “found” infant of unknown parentage.

Funeral director - A person licensed in this state to engage in the practice of preparing bodies of
dead persons for burial, and the directing and supervising of the burial or disposal of deceased
human bodies and responsible for the preparation and registration of certificates of death and
fetal death.

Gestational Surrogate - A woman who contracts to become pregnant by means of assisted
reproductive technology without the use of an egg from her body.

Informant - The person who supplies the data regarding the personal particulars required for the
preparation of a Certificate of Live Birth, Death, or Fetal Death. For birth, this must be a parent
of the child.

Live birth - The complete expulsion or extraction from its mother of a product of human
conception, irrespective of the duration of pregnancy, which, after such expulsion or extraction,
breathes or shows any other evidence of life such as beating of the heart, pulsation of the
umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has
been cut or the placenta is attached.

Local Registrar - The county health department director or administrator, who under the
direction of the state registrar of vital records, is in charge of the registration of births, deaths,
and fetal deaths within a specified local registration district. He has the further responsibility of
carrying out duties incidental to enforcement of vital statistics laws within his registration district.

Local registration district - A specific geographic area designated by the state registrar of vital
records as a part of the statewide vital records registration system. In our state, registration
districts conform to the jurisdictional boundaries of the county health departments.

Medical Examiner - A physician appointed by medical examiner district (not necessarily
contiguous with local registration districts) whose duty it is to investigate the circumstances and
determine the cause of death when the death is suspected or appears to have occurred by


Vital Records Registration Handbook, 2008 Revision                                                    130
                                                     GLOSSARY

criminal violence, by accident, homicide, suicide, death without medical attendance, in prison, or
under any suspicious or unusual circumstance. A further duty is the preparation of the medical
section of the death or fetal death record in those cases handled by him. The medical examiner
is a physician with special training in pathology.

Midwife - A person licensed to attend women at or during childbirth (other than a physician) and
who accepts compensation for these services.

Moving conveyance - Any means of transportation, public or private, such as bus, train, plane,
or automobile.

Bureau of Vital Records and Public Health Statistics - The office responsible under the state
registrar for the administration of vital statistics laws and regulations and the collection and
preservation of the vital records of Florida. In this manual, the term is synonymous with "the
state office."

Person in charge of interment - Any person who places, or causes to be placed, a dead body or
a dead fetus in a grave, vault, urn, or other receptacle or otherwise disposes of such remains.

Physician - A person authorized to practice medicine, osteopathic medicine, or chiropractic
medicine pursuant to chapter 458, chapter 459, or chapter 460, Florida Statutes.

Presumptive death - Determination by a court of competent jurisdiction that a death has
occurred or is presumed to have occurred in this state, but the body of the person involved has
not been located or recovered.

Putative Father - a man who believes he may have fathered a child and wishes to preserve his
rights to be noticed should the child be placed for adoption.

Putative Father Registry - the registry is where the putative father claim is filed and recorded.

Registrant - The child entered on a birth certificate, the deceased entered on a death certificate,
and both the husband and wife entered on a marriage or dissolution of marriage record.

Registration - The acceptance for filing of a Certificate of Live Birth, Death, or Fetal Death by the
local registrar.

Sexton - A person having charge of a cemetery or burial ground, either public or private.

State File Number - A number assigned to a vital record by the Bureau of Vital Statistics for
legal, index, and identification purposes.

State Registrar - The person specified by state law to direct the operations of the state office of
vital records and public health statistics and to oversee vital records registration in the districts.
He furnishes all necessary forms to local registrars and investigates violations of vital statistics
laws.

Subregistrar - A person appointed by the state registrar to receive death and fetal death
certificates and to issue Burial-Transit Permits in and for such portions of a registration district
as may be designated.



Vital Records Registration Handbook, 2008 Revision                                                     131
                                                     GLOSSARY

Surrogate - A woman who contracts to become pregnant by means of assisted reproductive
technology with the use of her own egg.

Vital records - Official and original certificates of birth, death, and fetal death. Also includes
records of marriage and dissolution of marriage.

Vital statistics laws - The Vital Statistics Act is legislation enacted to provide a system for
collection and preservation of vital records. The vital statistics act is located at Chapter 382,
Florida Statutes.

Vital statistics and records system - The registration, collection, preservation, amendment, and
certification of vital records, and activities related thereto, including the tabulation, analysis, and
publication of statistical data derived from such records.




Vital Records Registration Handbook, 2008 Revision                                                   132
                                      APPENDIX A
           FOREIGN OR HIGH-SEAS BIRTHS & DEATHS & CERTIFICATES OF CITIZENSHIP
Birth records of persons born in foreign countries                           6.   the signature of the requestor and the requestor's
who are U.S. citizens at birth                                                    relationship to the subject;
           The birth of a child abroad to U.S. citizen parent(s)             7. a check or money order for $30.00 for the FS-240,
should be reported to the nearest U.S. Consulate or Embassy as                    $30.00 for the first DS-1350 and $20.00 for each
soon after the birth as possible. To do this, the child's parent or               additional issued at the same time per document
legal guardian should file an Application for Consular Report of                  requested, made payable to the U.S. Department of
Birth Abroad of a Citizen of the United States of America (Form                   State; and
FS-579/SS-5). This form may also be used to apply for a Social               8. if applying for a replacement FS-240, a notarized
Security Number for the child. A $40.00 fee is charged for                        affidavit by the subject, parent, or legal representative
reporting the birth.                                                              that states the name, date and place of birth of the
      The application must be supported by evidence to establish                  subject, and the whereabouts of the original FS-240.
the child's U.S. citizenship. Usually, the following documents are           To obtain a Consular Report of Birth in a new name, send a
needed:                                                                 written request and fees as noted above, the original (or
      1. the child's birth certificate;                                 replacement) Consular Report of Birth, or if not available, a
      2. evidence of the U.S. citizenship of the parent(s) such as      notarized affidavit about its whereabouts. Also, send a certified
           a certified copy of a birth certificate, U.S. passport, or   copy of the court order or final adoption decree which identifies
           Certificate of Naturalization or Citizenship;                the child and shows the change of name with the request. If the
      3. evidence of the parents' marriage, if applicable; and          name has been changed informally, submit public records and
      4. affidavit(s) of the physical presence of the parent(s) in      affidavits that show the change of name.
           the United States.
      Each document should be certified as a true copy of the           Birth records of alien children adopted by U.S.
original by the registrar of the office that issued the document.       citizens
Other documents may be needed in some cases. Contact the                           Birth certifications for alien children adopted by U.S.
nearest U.S. Embassy or Consulate for details on what evidence is       citizens and lawfully admitted to the United States may be
needed.                                                                 obtained from the Immigration and Naturalization Service (INS)
      When the application is approved, a Consular Report of Birth      if the birth information is on file. (Address can be found in a
Abroad of a Citizen of the United States of America (Form FS-           telephone directory.) To obtain the birth data, it is necessary to
240) is given to the applicant. This document, known as the             provide the Immigration Office with proof of adoption or
Consular Report of Birth, has the same value as proof of                legitimation.
citizenship as the Certificate of Citizenship issued by the
Immigration and Naturalization Service.
                                                                        Certificate of citizenship
A Consular Report of Birth can be prepared only at a U.S.
                                                                                   Persons who were born abroad and later naturalized as
Embassy or Consulate overseas, and only if the person who is the
                                                                        U.S. citizens or who were born in a foreign country to a U.S.
subject of the report is under 18 years of age when the application
                                                                        citizen (parent or parents) may apply for a certificate of
is made. A person residing abroad who is now 18 years of age or
                                                                        citizenship pursuant to the provisions of Section 341 of the
over, and whose claim to U.S. citizenship has never been
                                                                        Immigration and Nationality Act. Application can be made for
documented, should contact the nearest U.S. Embassy or
                                                                        this document in the United States at the nearest office of the
Consulate for assistance in registering as a U.S. citizen.
                                                                        Immigration and Naturalization Service (INS). The INS will issue
           As of November 1, 1990, the U.S. Department of State
                                                                        a certification of citizenship for the person if proof of citizenship
no longer issues multiple copies of the Consular Report of Birth.
                                                                        is submitted and the person is within the United States. The
However, a replacement Consular Report of Birth may be issued
                                                                        decision whether to apply for a certificate of citizenship is
if the original document is lost or mutilated. The U.S. Department
                                                                        optional; its possession is not mandatory because a valid U.S.
of State also issues certified copies of the Certification of Report
                                                                        passport or a Form FS-240 has the same evidentiary status.
of Birth (DS-1365), which contains the same information as on
the Consular Report of Birth. The DS-1365 serves most needs and
can be issued in multiple copies. Documents are issued only to the      Death records of U.S. citizens who die in foreign
subject of the Consular Report of Birth, the subject's parents or       countries
legal guardian, or a person who submits written authorization                      The death of a U.S. citizen in a foreign country may be
from the subject.                                                       reported to the nearest U.S. consular office. If reported, and a
      To request copies of the DS-1365 or a replacement FS-240,         copy of the local death certificate and evidence of U.S.
write to Passport Services, Correspondence Branch, U.S.                 citizenship are presented, the consul prepares the official Report
Department of State, 1111 19th Street NW, Suite 510,                    of the Death of an American Citizen Abroad' (Form OF-180). A
Washington, DC 20522-1705. Please include the following items:          copy of the Report of Death is then filed permanently in the U.S.
      1. the full name of the child at birth (and any adoptive          Department of State (see exceptions below).
           name);                                                                  To obtain a copy of a report filed in 1975 or after, write
      2. the date and place of birth;                                   to Passport Services, Vital Records Section, U.S. Department of
      3. the names of the parents;                                      State, Washington, DC 20522-1705. The fee for a copy is $30.00
      4. the serial number of the FS-240 (if the FS-240 was             for the first copy, $20.00 for each additional copy. Fee may be
           issued after November 1, 1990);                              subject to change.
      5. any available passport information;
                                                                                                                                          115
                                                                  APPENDIX A
          Reports of Death filed before 1963 are maintained by             Services in the U.S. Department of State, which will provide the
the National Archives and Records Service, Diplomatic Records              certification service just as it does for similar records issued by
Branch, Washington, DC 20408. Requests for such records                    U.S. Embassies and Consulates abroad.
should be sent directly to that office.                                         To request copies, write to Correspondence Branch, Passport
          Reports of deaths of persons serving in the Armed                Services, U.S. Department of State, 1111 19th Street NW, Suite
Forces of the United States (Army, Navy, Marines, Air Force, or            510, Washington, DC 20522-1705. Please include the following
Coast Guard) or civilian employees of the Department of Defense            items for birth , death, or marriage:
are not maintained by the U.S. Department of State. In these                    1. the full name of subject at the time of event;
cases, requests for copies of records should be sent to the National            2. month, day and year of event;
Personnel Records Center (Military Personnel Records), 9700                     3. place of event (city and country);
Page Ave., St. Louis, Missouri 63132-5100.                                      4. parents' names, date and place of birth, and nationality
                                                                                      for birth record;
Records of birth and death occurring on vessels or                              5. any available U.S. passport information;
                                                                                6. signature of the requestor, parent or guardian, or legal
aircraft on the high seas
                                                                                      representative;
     When a birth or death occurs on the high seas, whether in an
                                                                                7. requestor address and telephone number;
aircraft or on a vessel, the record is usually filed at the next port
                                                                                8. a check or money order for $30.00 and $20.00 for each
of call.
                                                                                      additional copy issued at the same time, made payable to
     1. If the vessel or aircraft docked or landed at a foreign
                                                                                      U.S. Department of State. Do not send cash.
          port, requests for copies of the record may be made to
          the U.S. Department of State, Washington, DC 20522-
          1705.
     2. If the first port of entry was in the United States, write
          to the registration authority in the city where the vessel
          or aircraft docked or landed in the United States.
     3. If the vessel was of U.S. registry, contact the local
          authorities at the port of entry and/or search the vessel
          logs at the U.S. Coast Guard Facility at the vessel's final
          port of call for that voyage.

Records maintained by foreign countries
          Most, but not all, foreign countries record births and
deaths. It is not possible to list in this publication all foreign vital
records offices, the charges they make for copies of records, or
the information they may require to locate a record. However,
most foreign countries will provide certifications of births and
deaths occurring within their boundaries.
          Persons who need a copy of a foreign birth or death
record should contact the Embassy or the nearest Consulate in the
U.S. of the country in which the death occurred. Addresses and
telephone numbers for these offices are listed in the U.S.
Department of State Publication 7846, Foreign Consular Offices
in the United States, which is available in many local libraries.
Copies of this publication may also be purchased from the U.S.
Government Printing Office, Washington, DC 20402.
          If the Embassy or Consulate is unable to provide
assistance, U.S. citizens may obtain assistance by writing to the
Office of Overseas Citizens Services, U.S. Department of State,
Washington, DC 20520-4818. Aliens residing in the United States
may be able to obtain assistance through the Embassy or
Consulate of their country of nationality.



Records of birth, death, and marriage in the Panama
Canal Zone for U.S. citizens and foreign nationals
          From 1904 until 1979, the Canal Zone Government
registered all civil acts of birth, death, and marriage in the Canal
Zone for U.S. citizens and foreign nationals. Since 1979, the
Panama Canal Commission has issued certified copies of these
documents in response to requests from the public. On December
31, 1999, the Panama Canal Commission will no longer exist. On
December 1, 1999, those records were transferred to Passport
                                                                                                                                          116
                                          APPENDIX B


                                          WEB SITES

www.leg.state.fl.us
Chapter 382 – Vital Statistics
Chapter 119 – Public Records
Chapter 381 – Public Health
Chapter 406 – Medical Examiner
Chapter 458 – Physicians
Chapter 459 – Osteopaths
Chapter 460 – Chiropractic
Chapter 467 - Midwifery
Chapter 497 – Funeral, Cemetery, and Consumer Services
Chapter 742 -- Surrogacy
Chapter 872 – Offenses Concerning Dead Bodies and Graves (cremation authorization)

Chapter 64V-1 – Vital Statistics Florida Administrative Code/Rule:
http://fac.dos.state.fl.us

National Center for Health Statistics – “Where To Write For Vital Records:”
www.cdc.gov/nchs/howto/w2w/w2welcom.htm

Verify Florida license of funeral director, direct disposer or funeral establishment:
http://www.fldfs.com/FuneralCemetery/

Verify Florida license of physician or licensed midwife:
www.doh.state.fl.us/IRM00PRAES/pralist.asp

Verify Florida license of an attorney:
www.flabar.org

Check addresses for proper city and county:
www.usps.com




                                                                                        117
Charlie Crist                               Ana M. Viamonte Ros, M.D., MPH
Governor                                              State Surgeon General




                STATE OF FLORIDA




   OFFICE OF VITAL STATISTICS



     CHIEF DEPUTY REGISTRAR
       OPERATIONS MANUAL
       November 2009 Revision
                OFFICE OF VITAL STATISTICS
                      1217 Pearl Street
                        P.O. Box 210
                  Jacksonville, Florida 32231
INTRODUCTION
         Vital Statistics Staff
                                          TALLAHASSEE STAFF
                   C. Meade Grigg – State Registrar
                   Director Office of Health Statistics & Assessment
                                          JACKSONVILLE STAFF
                   Ken Jones – Deputy State Registrar
                   Gina Aldridge – Computer Specialist
                   Eric Mays – Computer Specialist
                   Ray Herz – Office Automation Specialist

                   Kevin Wright – Vital Records/Certifications
                   Kathy Stephens
                   Evelyn Fugate – Client Services
                   Darlene Newmans – Search/Distribution

                   Betty Shannon – Amendments
                   Gwen McNeil – Corrections, Paternity/Child Support Enforcement
                        Tina Crawford – Corrections, Legal Name Changes
                        Dorothy Palmer-- Paternity/Child Support Enforcement
                   Lorraine Kratz – Adoptions, Delays, Presumptive Deaths
                   Jim Ballard – Current Registration/Quality Assurance
                   Paula Mundy – Birth
                   Kenny Higginbotham – Death/Fetal Death, Marriage/Divorce
                   Sharon B. Dover – Quality Assurance
                        Mike Grant – Quality Assurance
                        Jana Duffy – Quality Assurance
                        Mike Edwards – Quality Assurance
                        Ana Goold – Quality Assurance
                        Chris Mays – Quality Assurance
                        Cindy Russ – Quality Assurance
                        Michele Watterson – Quality Assurance
                   Gary Sammet – Public Health Statistics
                   Felipe Lorenzo-Luaces – Data Management, Multiple Cause of Death
                   Classification
                   Velida Osmanovic – Data Management
                   Bill Hughes – Administrative Services
                   Vickie Cook – Fiscal
                   Michelle Campbell – General Services/Purchasing


Chief Deputy Registrar Operations Manual, 2009 Revision
INTRODUCTION
          Chief Deputy Registrar Advisory
               Committee (CDRAC)
                            Luz Perez, Hillsborough County – Committee Chair
                            Willie Dean Mayo, Columbia County, North/Northwest Florida
                            Janie Carpenter, Escambia County, North/Northwest Florida
                            Alexa Hudson, Brevard County, Central Florida
                            Pat Kennedy, Flagler County, Central Florida
                            Gloria Norfleet-Robinson, Osceola County, Central Florida
                            Chris Mashintonio, Charlotte County, Southwest Florida
                            Eva Williams, Broward County, Southeast Florida




Chief Deputy Registrar Operations Manual, 2009 Revision
FORWARD

                                      The Chief Deputy Registrar Operations Manual is designed to
                                      assist the local registrar, chief deputy registrar and deputy
                                      registrar with the daily functions of the vital statistics office.
                                      The topics include: registration and certification of vital
                                      records, training materials for those originating vital records,
                                      office procedures for handling safety paper, filing of vital
                                      records, and reference materials needed in the daily operation
                                      of the vital statistics office. The procedures recommended are
                                      based on Florida Statutes and Florida Administrative Code.

                                      The topics of issuance and access to vital records generate
                                      many questions. This manual provides a guideline on who
                                      may obtain vital records and the type(s) of identification that
                                      may be required. The e-Vitals System is the electronic
                                      mechanism whereby all vital records are entered into the state
                                      database, certifications are issued, applicants are tracked,
                                      safety paper usage is monitored, and funds are accounted for.
                                      There is a separate e-Vitals Training Manual with detailed
                                      procedures related to the system operation, which can be
                                      found on the department Intranet website at: http://dohiws/. It
                                      is listed under “Health Statistics”.

                                      This operations manual will help ensure uniform procedures
                                      among the 67 vital statistics offices throughout Florida. It is
                                      intended to act as a companion to the Vital Records
                                      Registration Handbook, which provides detailed instructions
                                      on the completion of vital records.

                                      The state office welcomes and solicits any comments or
                                      recommendations regarding this manual that will increase its
                                      value to the users.

                                                                             C. Meade Grigg
                                                                             State Registrar
                                                                             Office of Vital Statistics
                                                                             November 2009




Chief Deputy Registrar Operations Manual, 2008 Revision
Chief Deputy Registrar Operations Manual, 2009 Revision
                                                      TABLE OF CONTENTS


INTRODUCTION

FORWARD

      CHAPTER 1 – APPOINTMENT OF REGISTRARS ....................................................................... 5
       LOCAL REGISTRARS................................................................................................................. 5
       CHIEF DEPUTY REGISTRARS AND DEPUTY REGISTRARS................................................. 5
       CHIEF DEPUTY REGISTRAR ADVISORY COMMITTEE (CDRAC) ......................................... 5
       SUBREGISTRARS WITHIN FUNERAL ESTABLISHMENTS..................................................... 6
       TERMINATION OF REGISTRARS ............................................................................................. 7
      CHAPTER 2 – FUNCTIONS OF LOCAL VITAL STATISTICS OFFICES ...................................... 9
       MINIMUM FUNCTIONS............................................................................................................... 9
       SELF ASSESSMENT TOOL (SAT)............................................................................................. 9
       MAINTAIN LOCAL FILE COPIES ............................................................................................. 10
       RECORDS DESTRUCTION...................................................................................................... 10
       RETENTION OF VITAL RECORDS.......................................................................................... 10
       FORMS...................................................................................................................................... 11
       FISCAL RESPONSIBILITIES .................................................................................................... 12
       UNUSUAL INCIDENTS ............................................................................................................. 12
       COOPERATION WITH SOCIAL SERVICE AGENCIES ........................................................... 12
       THE WELL-EQUIPPED VITAL STATISTICS OFFICE.............................................................. 13
      CHAPTER 3 - REVIEW and TRANSMITTAL OF RECORDS...................................................... 15
       REVIEW OF RECORDS UPON RECEIPT ............................................................................... 15
       STANDARDS OF ACCEPTABILITY FOR VITAL RECORDS................................................... 15
       REGISTRARS’ SIGNATURES .................................................................................................. 16
       NOTATIONS ON RECORDS .................................................................................................... 16
       TRANSMITTAL OF RECORDS TO STATE OFFICE................................................................ 17
       SPECIAL REQUESTS FOR RECORDS ................................................................................... 18
       QUERY ON INCOMPLETE RECORDS .................................................................................... 18
       BIRTH, DEATH, OR FETAL DEATH THAT OCCURS IN ANOTHER REGISTRATION
       DISTRICT/COUNTY .................................................................................................................. 19
      CHAPTER 4 - SAFETY PAPER ................................................................................................... 21
       ORDERING ............................................................................................................................... 21
       VERIFICATION UPON RECEIPT OF SHIPMENT.................................................................... 22
       DISCREPANCY/INCIDENT REPORTING ................................................................................ 24
       REQUIRED LOGS..................................................................................................................... 24
       ACCOUNTING FOR USE OF PAPER ...................................................................................... 25
       TRANSFER OF PAPER ............................................................................................................ 26
       STORAGE OF SAFETY PAPER............................................................................................... 27
      CHAPTER 5 – ISSUANCE and CERTIFICATIONS ..................................................................... 29
       EXTENSION OF CREDIT FOR CERTIFIED COPIES .............................................................. 30
       HOW TO ISSUE CERTIFIED COPIES ..................................................................................... 30
       FORMS OF IDENTIFICATION .................................................................................................. 31
       BIRTH RECORD ....................................................................................................................... 33
       OTHER RECORDS (DEATH AND FETAL DEATH) ................................................................. 36
       TELEPHONE VERIFICATIONS ................................................................................................ 38
       CERTIFICATE OF BIRTH RESULTING IN A STILLBIRTH – (KATHERINE’S LAW)............... 38
       EMANCIPATED MINOR............................................................................................................ 38
       APOSTILLE OR EXEMPLIFIED COPIES OF VITAL RECORDS............................................. 38
       OTHER COPIES OF VITAL RECORDS ................................................................................... 39
       KEYING ERRORS..................................................................................................................... 39
       RECORDS WITH ALERT MESSAGES..................................................................................... 40
       MISSING CHILDREN ................................................................................................................ 41
       SUBPOENAS ............................................................................................................................ 42




Chief Deputy Registrar Operations Manual, 2009Revision                                                                                              i
                                                         TABLE OF CONTENTS


      CHAPTER 6 - PENALTIES FOR VIOLATION OF VITAL STATISTICS LAWS .......................... 43
       TIMELY FILING OF RECORDS ................................................................................................ 43
       DEATH REGISTRATION DELAY REPORT, DH 1355 ............................................................. 43
       NONCOMPLIANCE ................................................................................................................... 44
      CHAPTER 7 - ADOPTIONS ......................................................................................................... 47
       BIRTH RECORDS FOLLOWING ADOPTION PROCEEDINGS .............................................. 47
       FLORIDA PUTATIVE FATHER REGISTRY ............................................................................. 47
      CHAPTER 8 - BIRTH OCCURRING OUTSIDE A FACILITY, (HOME BIRTH)........................... 49
      CHAPTER 9 - OTHER BIRTH REGISTRATION ISSUES ........................................................... 51
       HOSPITALS RESPONSIBLE FOR FILING BIRTH RECORD .................................................. 51
       NON-INSTITUTIONAL DELIVERY............................................................................................ 51
       BIRTH OCCURRING IN ANOTHER REGISTRATION DISTRICT (COUNTY)......................... 51
       INFANT BIRTH/DEATH MATCH............................................................................................... 52
       E-VAULT PRINT SYSTEM........................................................................................................ 53
       ENUMERATION AT BIRTH....................................................................................................... 54
       HUSBAND TO BE SHOWN ...................................................................................................... 54
       ACKNOWLEDGEMENT OF PATERNITY................................................................................. 55
       PLURAL BIRTHS....................................................................................................................... 56
       FOUNDLINGS ........................................................................................................................... 56
       SAFE HAVEN/SURRENDERED BABIES ................................................................................. 57
       LATE REGISTRATION OF BIRTHS ......................................................................................... 58
       DELAYED BIRTH RECORDS ................................................................................................... 58
       BIRTHS THAT OCCURRED IN OTHER STATES, OUTLYING U.S. AREAS, AND OVERSEAS
       BIRTHS INVOLVING U.S. NATIONALS ................................................................................... 58
       BIRTH NOTIFICATION.............................................................................................................. 59
       HEALTHY START ..................................................................................................................... 59
       SURROGATE MOTHER OR GESTATIONAL SURROGACY (S. 382.013, 742.16, F.S.) ....... 60
       ELECTRONIC BIRTH REGISTRATION SYSTEM.................................................................... 60
      CHAPTER 10 - DEATH REGISTRATION .................................................................................... 61
       FUNERAL DIRECTOR/DIRECT DISPOSER'S RESPONSIBILITY TO FILE DEATH RECORD
       ................................................................................................................................................... 61
       USE OF THE BURIAL-TRANSIT PERMIT................................................................................ 61
       ISSUANCE OF BURIAL-TRANSIT PERMITS .......................................................................... 62
       BURIAL WITHOUT PERMIT ..................................................................................................... 63
       DEATH THAT OCCURS IN ANOTHER REGISTRATION DISTRICT (COUNTY).................... 63
       DISINTERMENT/REINTERMENT PERMIT .............................................................................. 63
       PHYSICIAN’S RESPONSIBILITY IN DEATH REGISTRATION ............................................... 63
       WHO MAY SIGN MEDICAL CERTIFICATION ......................................................................... 64
       PROBLEM GETTING PHYSICIAN TO SIGN RECORD ........................................................... 65
       RESPONSIBILITY IN DEATHS WITHOUT MEDICAL ATTENDANCE .................................... 66
       TEMPORARY (PENDING) DEATH RECORDS (S. 382.008(4, 5), F.S.).................................. 67
       UNIDENTIFIED BODIES........................................................................................................... 68
       REVIEWING DEATH RECORD FOR TRAUMA IN CAUSE OF DEATH.................................. 68
       CORRECTION OF DEATH CERTIFICATES ............................................................................ 70
       LETTER OF NON-CONTAGIOUS DISEASE............................................................................ 71
       DELAYED DEATH CERTIFICATES.......................................................................................... 71
       INFANT DEATH/BIRTH MATCH............................................................................................... 72
       PRESUMPTIVE DEATHS ......................................................................................................... 72
       BURIAL OF HUMAN REMAINS AT SEA (EPA REGION 4) ..................................................... 73
       FAMILY MEMBER ACTING AS FUNERAL DIRECTOR........................................................... 73
      CHAPTER 11 -- FETAL DEATH REGISTRATION....................................................................... 75
       DEFINITION .............................................................................................................................. 75
       FETAL DEATH REGISTRATION (S. 382.008(1), F.S.) ............................................................ 75
       SIGNATURES REQUIRED ....................................................................................................... 76
       RESPONSIBILITY IN FETAL DEATH REGISTRATION........................................................... 76
       DISPOSITION OF THE FETUS ................................................................................................ 77



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                                                      TABLE OF CONTENTS


        CONFIDENTIALITY................................................................................................................... 77
      CHAPTER 12 – DISASTER PLAN ............................................................................................... 79
      GLOSSARY OF TERMS ..............................................................................................................83
      WEB SITES .................................................................................................................................. 89
      FOREIGN OR HIGH-SEAS BIRTHS AND DEATHS AND CERTIFICATES OF CITIZENSHIP .. 91
      SAMPLE NONCOMPLIANCE LETTER TO HOSPITAL FOR LATE BIRTH CERTIFICATES.... 93
      SAMPLE NONCOMPLIANCE LETTER TO MIDWIFE FOR LATE BIRTH CERTIFICATES ....... 94
      SAMPLE NONCOMPLIANCE LETTER FOR LATE DEATH CERTIFICATE............................... 95
      SAMPLE NONCOMPLIANCE LETTER FOR LATE BURIAL-TRANSIT PERMIT ....................... 96
      SAMPLE NONCOMPLIANCE LETTER FOR LATE FETAL DEATH CERTIFICATE .................. 97
      SAMPLE NONCOMPLIANCE LETTER TO PHYSICIAN ............................................................. 98
      FACSIMILE SIGNATURE FOR CDR ........................................................................................... 99
      APPLICATION FOR APPOINTMENT OF SUBREGISTRAR OF VITAL STATISTICS.............. 109
      HOME BIRTHS ........................................................................................................................... 113
        INVENTORY OF SAFETY PAPER LOG................................................................................. 121
      E-VAULT PRINT INSTRUCTIONS............................................................................................. 123




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                                               TABLE OF CONTENTS




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                                       CHAPTER 1 – APPOINTMENT OF REGISTRARS




                    CHAPTER 1 – APPOINTMENT OF REGISTRARS
                                               LOCAL REGISTRARS

The county health department director or administrator is traditionally appointed as the local
registrar for that registration district (county). Such appointment is made by the state
registrar, with the seal of the department affixed to the commission.

Local registrars are responsible for the local vital statistics programs, and under the direction
of the state registrar, are charged with the enforcement of vital statistics laws, regulations,
and instructions within their county. There is a brief course in Trak-it that provides the local
registrar with an overview of their vital statistics office. It is recommended that any new local
registrar take this course.

Persons appointed as local registrars should appreciate the importance of proper
registration of vital records to the individual and to the community. Registrars should be
familiar with vital statistics laws, regulations, and instructions and strive to establish a good
rapport with physicians, funeral directors, hospitals, and others involved in the vital records
registration process.

                    CHIEF DEPUTY REGISTRARS AND DEPUTY REGISTRARS

Upon acceptance of appointment, each local registrar must designate a chief deputy
registrar (CDR) and may designate other deputy registrars (s. 382.005(4), F.S.).
Recommendations of persons for the position are submitted to the state registrar, and
appointment procedures are similar to those for local registrars. The person appointed as
chief deputy registrar will act in the absence or disability of the local registrar. Each chief
deputy and deputy registrar should accept his/her appointment in writing and is subject to
the same laws, regulations, and instructions governing the local registrar. Copies of the
acceptance forms can be found in the back of this manual.

All deputies should be familiar with office operations and be available to manage vital
statistics matters in the absence of the CDR. There is course in Trak-it for CDR/DR Duties
and Responsibilities. Each new CDR and deputy must successfully complete this course.

Traditionally, the CDR assumes the responsibility of managing the day-to-day operations of
the vital statistics unit. There are times and circumstances when the CDR will look to the
local registrar to assist in specific situations.

                 CHIEF DEPUTY REGISTRAR ADVISORY COMMITTEE (CDRAC)

There is an elected advisory group made up of chief deputy registrars from eight different
Florida counties. The group is structured so that small, medium, and large counties each
have two representatives. Ideally, there are two representatives from four areas: southeast,
southwest, central, and north (includes the panhandle).

When there is a vacancy, the state office first determines what size county is needed and
from what area. An inquiry is made to those specific counties, asking for interested CDRs.
These names are put forward, with a brief bio, and all CDRs have the opportunity to vote for
whomever they feel is the best candidate. If there is no one interested from that area, the



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                                       CHAPTER 1 – APPOINTMENT OF REGISTRARS




call goes out statewide, asking for interested CDRs, and those names are put to a statewide
vote.

Anyone considering a place on the CDRAC should consider:

     1. CDRAC is called upon to assist the state office in reviewing various proposed
         training materials, policies and procedures;
     2. CDRs may be asked to survey their region on specific questions that arise;
     3. The term lasts generally from 4-6 years;
     4. The CDRAC physically meets about once a year -- usually in Jacksonville, but not
         exclusively.
         a. If the CDRAC meeting is called by the state office, the state office usually pay the
             travel expenses. If the meeting is called by the CDRAC then the county would
             be expected to pay the expenses.
         b. Historically, meetings have been for two to three days.
     5. The CDRAC has monthly conference calls following the monthly CDR call and other
         times, as needed;
     6. The CDR must have the approval of your local registrar prior to submission of your
         name to the committee;
     7. It is important that the CDR participate in all CDRAC activities;
     8. The CDR must have the permission of the local registrar to act in this capacity;
     9. The CDR must be able to travel and not leave a hardship on the office; and
     10. The CDR must be a team player.

                     SUBREGISTRARS WITHIN FUNERAL ESTABLISHMENTS

The state registrar may appoint one or more subregistrars for each licensed funeral
establishment based upon the recommendation of the funeral director in charge and the
local registrar (s. 382.003 (9), F.S.). These subregistrars are subject to the supervision and
control of the state registrar and to the same penalties for neglect of duty as all deputy
registrars. A licensed funeral director may be appointed as a subregistrar, but is prohibited
from issuing a burial-transit permit to him/her self when in charge of a particular decedent.

Each subregistrar must:
   1 Be commissioned as a notary public in the state of Florida;
   2 Complete a subregistrar training class conducted by the CDR; and
   3 Complete the subregistrar application.

The subregistrar’s commission will indicate that he/she is authorized to issue burial-transit
permits for deaths that occur anywhere within the state. The subregistrar must forward the
pink copy of the burial-transit permit to the local registrar where death occurred within 24
hours after issuance. Death records must be reviewed, signed, dated and forwarded by the
subregistrar or funeral director to the local registrar of the county where death occurred,
within 24 hours after receipt from the physician responsible for completing the medical
certification.




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                                       CHAPTER 1 – APPOINTMENT OF REGISTRARS




                                       TERMINATION OF REGISTRARS

Subregistrars may be terminated from such positions by the state registrar as the result of
their neglect or failure to properly perform the duties of the office. In addition to removal
from office, such penalties as are provided by law may be imposed for violation of vital
statistics laws.




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                              CHAPTER 2 – FUNCTIONS OF LOCAL VITAL STATISTICS OFFICES




  CHAPTER 2 – FUNCTIONS OF LOCAL VITAL STATISTICS OFFICES

                                               MINIMUM FUNCTIONS

A summary of the minimum functions of the county vital statistics office includes:
    1. Assist in the enforcement of the state law relating to the registration of vital records in
       the county;
    2. Complete annual Self Assessment Tool (SAT);
    3. Review of records for completeness and accuracy before acceptance;
    4. Review of cause of death entries on death and fetal death records for possible
       medical examiner jurisdiction;
    5. Daily transmittal of the original records to the state registrar;
    6. Daily reconciliation of transmittals returned from state office;
    7. Monitor timeliness in filing of vital records; follow-up on late filing of records;
    8. Provide training and assistance to hospital personnel, midwives, funeral directors,
       physicians and medical examiners in connection with the preparation and filing of
       vital records;
    9. Issuance of Burial-Transit Permits for disposal of bodies for those deaths that occur
       in their county;
   10. Preparation and preservation of local file copies and indices as appropriate;
   11. Attend scheduled state office training sessions and conference calls;
   12. Preparation of certified copies of vital records in response to public requests
       (optional);
   13. Preparation of statistical summaries and reports (optional); and
   14. Review and maintain required safety paper logs for an accounting of all safety paper
       utilized in issuance of certifications;
   15. Notification of facility name changes, new hospitals and new birthing centers; this
       notice should be done prior to sending records to the state office.

                                       SELF ASSESSMENT TOOL (SAT)

The annual Self Assessment Tool (SAT) was developed to assist the local vital statistics
office in ongoing process improvement activities. The SAT is completed, via SharePoint, by
the Chief Deputy Registrar, reviewed and signed by the Business Manager and Local
Registrar. Any comments related to specific items or the overall assessment should be
noted. Any items requiring follow-up or further discussion will be addressed by the quality
assurance unit. The SAT has been incorporated into the County Health Department annual
Quality Improvement Report.

The Business manager is charged with the responsibility of monitoring select items/tasks
from the SAT. One item on the SAT asks if the business manager does a quarterly review
of the vitals office. This review is mainly related to safety paper – monthly inventory,
handling and use of paper, and general accountability for all safety paper assigned to the
county health department. There are also questions related to other day to day CDR
responsibilities. The business manager should be sure the county registrars are following
established procedures. It is suggested that the CDR construct a sign-in sheet for the
business manager to document their review.




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                              CHAPTER 2 – FUNCTIONS OF LOCAL VITAL STATISTICS OFFICES




                                        MAINTAIN LOCAL FILE COPIES

The local registrar may make and preserve a local record of each birth, death, and fetal
death record registered by the county office, keeping these in a manner acceptable to the
state registrar. Photocopies and microfilmed copies are approved by the state registrar.
Separate files should be maintained on each type of vital record.

The state office suggests that counties maintain no more than the current and prior year of
birth records, since all issuance should be coming from the centralized database. It is
suggested that no more than five years of death file copies be maintained. Statistics show
that 98% of death copies are requested within the first two years from the date of death.

There is no particular vital record filing system mandatory for local registrars. The following
method has been found useful, with modifications dependent upon the volume of records
filed:
     1. Records may be kept in alphabetical order, by date of occurrence;
     2. The current year’s records are filed chronologically, by type of event and a computer
        or printed card index file is prepared in alphabetical order; and
     3. The records may or may not be bound periodically in permanent volumes in
        chronological order;

In smaller counties, filing records each year in alphabetical order with no index prepared has
proven to be adequate.

If a local office wants to destroy old local file copies, you should refer to the RECORDS
DESTRUCTION section of this chapter.

                                            RECORDS DESTRUCTION

If the county office wants to destroy local file copies, they are instructed to contact the state
office before doing so. Contact via email, Ray Herz, Retention Officer; and Darlene
Newmans, Search Unit. Once it has been determined that your file copies are not needed
here at the state office, you may proceed with destruction. If you destroy the copies
yourself, you must send an email to Ray Herz, providing the details of what event and what
years were destroyed. If the copies are shredded by an outside source, you must forward
Ray Herz a copy of the Certificate of Destruction.

                                      RETENTION OF VITAL RECORDS

See the General Records Retention Schedule GS1-SL, effective 11/1/06:
http://dohiws/Divisions/Administration/formsadmin/CenSupport/Retention/Schedules/New_G
S1-SL.pdf Page 8, Section VII(A) refers to Florida Administrative Code (F.A.C):
http://dlis.dos.state.fl.us/barm/rules/1B26_003FAC.cfm, covering any type of master
electronic record. Chapter 1B-26.003, F.A.C., Records Management – Standards and
Requirements - Electronic Recordkeeping, provides standards for record (master) copies of
public records which reside in electronic recordkeeping systems.

Florida statutes impose various retention schedules on different types of records.
    1. Local file copies of vital records are to be maintained until deemed obsolete,
        superseded, or their administrative value is lost. The state office maintains the
        original of all vital records. The state office must be notified, in writing or by e-mail:


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                              CHAPTER 2 – FUNCTIONS OF LOCAL VITAL STATISTICS OFFICES




          a. If shredded by an outside source; provide a copy of the certificate of destruction;
          b. If shredded internally (CDR or CHD staff); provide a written notice of destruction
              and the date destroyed;
          c. Before destruction of any local file copies; include:
              1). Type of records;
              2). Dates of events;
          d. The state office will maintain correspondence for 5 fiscal years.
     2.   All manual safety paper logs and related files are to be maintained for 5 fiscal years;
     3.   Burial-transit permits (pink and white copies) should be maintained for 3 fiscal years;
     4.   Noncompliance letters and all related files should be maintained for 3 fiscal years;
     5.   The AFS is the electronic application
          a. If all information on the AFS is complete, there is no need to maintain hard
              copies of the application as the e-vitals system archives this data and meets the
              retention requirements;
          b. If the AFS is not complete, hard copy applications must be maintained for five
              (5) fiscal years (they fall under the heading of Cash Receipts);
          c. Requests requiring documentation must be maintained for one year, along with
              documentation presented. All pertinent information related to that documentation
              must be entered on the Internal Notes tab:
              1). Court orders have a number and date issued that can be entered and
                  referenced back to the court if necessary. Any other pertinent information
                  provided by the court order should also be entered.
              2). Notarized affidavits/statements/powers of attorney, etc. have no reference
                  back to any source other than the applicant, so all pertinent information must
                  be entered, such as date written, who wrote it and their relationship to the
                  registrant, what it allowed, if there was a reference to expiration, etc.
     6.   Administrative Correspondence must be maintained for 3 fiscal years;
     7.   General instructions, policies and procedures received from the state office must be
          maintained until deemed obsolete, superseded or their administrative value is lost.

If there are questions regarding the retention of certain vital statistics documents, the CDR
should check with the local retentions officer or contact the state office.

                                                         FORMS

Local registrars must supply the required standard blank record forms to such persons as
may be in need of them within their own county. Registrars must not devise any forms for
use as original records but should issue and accept only those approved by the state
registrar. A detailed catalog of available forms is located on the department web site under
“Publications.” Any problem with forms, misprints, etc. should be reported to the state office
when noted.

Local registrars are to requisition needed vital statistics forms from the department on a
requisition form provided for this purpose. Local offices should keep a two-month supply on
hand. In the attachments of this manual there is a list of recommended forms to be kept on
hand in the county office. Many forms are now available on the department’s intranet and
Internet web sites. Please check these sites before ordering forms. Questions regarding
the ordering of forms should be directed to the purchasing agent at the state office in
Jacksonville. All forms should be kept in a secure area.




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                              CHAPTER 2 – FUNCTIONS OF LOCAL VITAL STATISTICS OFFICES




There are several approved software packages for generating forms, for both hospitals and
funeral directors. All self-generated forms must look like those forms provided by the state
office. Any variation makes the form unacceptable. For a list of approved software
packages, contact the state office.

Detailed instructions as may be required to secure the uniform observance of a successful
system of registration should also be made available to area professionals. These
instructions include the Vital Records Registration Handbook, and other training materials
such as the instructions for registering home births.

                                           FISCAL RESPONSIBILITIES

The state office makes certain recommendations regarding fiscal activity within the vitals
office. However, fiscal responsibilities within the vitals offices often come under the direction
of the business manager or other financial officer within the county health department.

The following are considered to be best business practices for the vitals office as they relate
to the intake of money:
    1. Mail, if received in the vitals office, should be opened the same day it is received;
    2. Any cash, if the vitals office takes the money, must be logged in immediately;
    3. Checks received should be endorsed immediately;
    4. Requests containing money should be logged into e-Vitals immediately upon receipt;
    5. CDR Transaction Report is reviewed daily for issuance of Courtesy Copy and
        Replacement Copy; this should be done not only by the CDR , but also the business
        manager at their monthly review;
    6. Multiple tellers should not use the same cash drawer;
    7. Tellers should close out and balance daily;
    8. Daily deposits should be made by someone other than the teller;
    9. If, for some reason, the teller and the depositor must be the same person, a second
        person should verify the financial transaction.

                                               UNUSUAL INCIDENTS

Incidents that seem unusual or suspicious should be reported immediately to the state
office, quality assurance unit, as well as to the county vital statistics supervisor and local
registrar, depending on the severity of the incident. At that time a review will be done to
determine if an incident report should be done, if law enforcement needs to be contacted, or
what steps need to be taken. Some examples of such an incident might be: evidence that a
possible fraudulent record may have been filed, a possible lost shipment of vital records
(see Ch.3, Review & Transmittal of Records), or anything that may make you feel
uncomfortable.

                         COOPERATION WITH SOCIAL SERVICE AGENCIES

Local registrars may make information from their birth records available to local social
service agencies for official purposes, if the agency does not have access to the vital
statistics database. This must be done according to procedures outlined in Chapter 5 of this
manual.




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                              CHAPTER 2 – FUNCTIONS OF LOCAL VITAL STATISTICS OFFICES




These agencies must be continually aware of the confidential nature of their work and the
confidentiality of vital records. Representatives of these agencies are not allowed to give
birth record information or copies to clients.

Requests for information on births occurring outside the registrar’s county should be referred
to the appropriate county or to the state office.

                          THE WELL-EQUIPPED VITAL STATISTICS OFFICE

A. Reference Materials
   1. CDR Operations Manual (for CDR, DR and LR use only);
   2. Vital Records Registration Handbook (for CDR/DR, hospitals, midwives, funeral
       directors, subregistrars and medical examiners);
   3. Florida Statutes (F.S.) and Florida Administrative Code (F.A.C.), with their link to the
       website:
       a. Chapter 382, F.S.; www.leg.state.fl.us
       b. Chapter 64V-1, F.A.C.; http://fac.dos.state.fl.us/
       c. Section 406.11 and .12, F.S. (ME statute); www.leg.state.fl.us
   4. e-Vitals Manual and all associated reference materials;
   5. Self Assessment Tool (SAT);
   6. Vital Statistics newsletter, Vital News;
   7. Posted for public view
       a. “Who Can Get Copies” — copy of s. 382.025 F.S., to be posted for public
            reference;
       b. Four major types of photo ID posted for public;
       c. Warning/disclaimer: “To obtain and use a Florida vital record under false or
            fraudulent purposes is a third- degree felony, punishable by the terms and
            conditions set forth in Florida Statutes;”
  8. Statewide list of county phone numbers, addresses, fees and Vital Statistic staff;
  9. State office phone list of Vital Statistic staff;
  10. Phone card for state office number, to be used for client referrals;
  11. File for each hospital, birthing facility, midwife, funeral home/direct disposer,
       physician and medical examiner. Include name of contact person and their phone
       number.
  12. Name and telephone numbers of Quality Assurance Field Representatives at state
       office;
   13. Procedures – anything special, not covered in manual or handbook; other
       memos/emails from state office;
B. Training Materials
   1. Vital Records Registration Handbook;
   2. Florida Statutes and Florida Administrative Code;
       a. Ch. 382, F.S.;
       b. Ch. 64V-1, F.A.C.;
       c. S. 406.11 and .12, F.S.;
   3. Vital News;
   4. Trak-It training modules
       a. Chief/Deputy Registrar – Duties & Responsibilities
       b. Florida Vital Statistics - Local Registrar Perspective
       c. Vital Statistics & the Role of the Business Manager
   5. Fetal Death Video;



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                              CHAPTER 2 – FUNCTIONS OF LOCAL VITAL STATISTICS OFFICES




   6. Subregistrar Training DVD or Video and Facilitator’s Guide (be sure you have all
       materials outlined in the guide);
   7. Physician training materials
       a. Informational brochure, “What the Physician Should Know about Certifying
           Cause of Death on the Florida Death Certificate”, DH 150-849;
       b. “Yellow card” -- NCHS instruction sheet for completing cause of death (COD);
       c. “Blue card” – instruction sheet for completing cause of fetal death;
C. Available forms – for a complete listing of forms and brochures, check the forms catalog
   on the DOH warehouse web site at:
   http://dohiws/Divisions/Administration/FormsAdmin/Forms/DCcatalog.xls

     The state office, Administrative Services Unit sends a monthly listing of forms availability
     and there is a detailed listing in the attachments to this manual.




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                                    CHAPTER 3 – REVIEW & TRANSMITTAL OF RECORDS




            CHAPTER 3 - REVIEW and TRANSMITTAL OF RECORDS

Registrars are responsible for the proper registration of births, deaths, and fetal deaths
occurring within their county; the issuance of required burial-transit permits; and for the
maintenance of proper records and files. To ensure completeness of registration within
his/her county, the local registrar may arrange to be furnished with a monthly list of births,
deaths, and fetal deaths occurring in each hospital within their county. Midwives may also
provide a list of births. All of these should be checked against records received.

                                  REVIEW OF RECORDS UPON RECEIPT

When a vital record is presented for registration, the local registrar should have it examined
carefully for errors and omissions. If there is a question regarding the acceptability of a
record, the Vital Records Registration Handbook contains chapters on birth, death and fetal
death records, with item-by-item instructions on their proper completion.

Upon receipt of the birth records from the hospital, the CDR must date item 13 on the
record, indicating the date the record was received in the health department. This date
assists in determining hospital compliance with required timeframes for filing records. Upon
receipt of the death certificate from the funeral director, the CDR must date item38b on the
record. This date assists the state office in determining funeral director compliance with
required timeframes for filing records.

If missing or incorrect information is found, the record cannot be accepted for registration.
The registrar should immediately notify the originator of the record (funeral director, hospital
staff, etc.) and return it for completion and/or correction. Under no circumstances is the
registrar to make any change, fill in blank items, or make any alteration to the record. The
local vital statistics office has no authority to add or correct information on vital records.

When the local registrar is satisfied that the record is in compliance, is accurate and
complete, the record is accepted for registration. A copy of the record is made for local files,
and the original record sent to the Office of Vital Statistics in accordance with the prescribed
schedule.

                     STANDARDS OF ACCEPTABILITY FOR VITAL RECORDS

Acceptable vital records should normally not show alterations, strikeovers, traceovers, or
erasures. All items must be clear and legible. If an error has been made in preparation by
the hospital staff, physician, funeral director, or midwife, a new record should be prepared.

Abbreviations should be avoided if space permits making the entry in full. Each item should
be completed, unless there are specific instructions to the contrary. Each record must be an
original on a form approved by the department. Facsimile signatures are not acceptable for
authenticating vital records by physicians, funeral directors, midwives, medical examiners, or
other officials responsible for filing.




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                                    CHAPTER 3 – REVIEW & TRANSMITTAL OF RECORDS




Registrars should normally not accept records containing any of the following defects:
   1. Whiteout, erasures, alterations, or obvious additions;
   2. Omission of items unless such omission is satisfactorily accounted for;
   3. Rubber stamp or typewritten signatures - an original signature is required;
   4. Traceovers;
   5. A record marked "copy" or "duplicate";
   6. Obviously improper or erroneous information;
   7. A form other than the state supplied form or one generated from a state-approved
       software package;
   8. A record not typewritten;
   9. Information relative to the father of a child born to an unmarried mother, unless both
       the mother and father sign the completed paternity acknowledgment on the front of
       the birth record. This does not preclude acceptance of such information when a
       court of competent jurisdiction has determined paternity.

                                          REGISTRARS’ SIGNATURES

All completed records registered directly with the local or chief deputy registrar should be
signed by the receiving registrar and show the date on which such record is received. All
signatures on vital records must be original. Use of a signature stamp is not permitted,
unless a special waiver has been granted by the state office. Records should not be signed
until after they have been reviewed and accepted for filing.

Signatures on certifications should be original signatures unless the signature has been
registered with the Secretary of State and permission granted to utilize a facsimile signature
stamp or template. Procedures on obtaining this permission are provided as an attachment
to this manual. Only the Chief Deputy Registrar is allowed the issuance of a duly obtained
facsimile signature; deputies are not authorized to do so. With the CDR’s permission,
deputies are allowed to use the CDR’s facsimile on certifications. These facsimile signature
stamps must be secured at all times and a record should be maintained of which staff has
access to them.

Birth records are not signed by the local registrar, but are initialed in item 13, Date Filed by
Registrar. The initials should be made after the file date is entered. They should be after
the parentheses and large enough to discern the letters.

                                           NOTATIONS ON RECORDS

Birth record -- Notification of prospective adoptions or that a child is deceased should be
written in pencil in the upper right margin of the reverse side of the birth record. A note
providing justification for any item entry should go in the upper right margin of the reverse
side of the record.

Death record -- Permanent or replacement death and fetal death records should be
identified by use of the “Permanent Record” stamp or pencil notation on the reverse side of
the record. A note for medical classification indicating a seemingly traumatic COD that is
actually pathological and therefore non-traumatic; which is to be written by the CDR on the
death record, in pencil in the lower left margin beside item 41, Cause of Death. A note
providing justification for any item entry should go in the top margin on the back of the
record.



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                                    CHAPTER 3 – REVIEW & TRANSMITTAL OF RECORDS




                           TRANSMITTAL OF RECORDS TO STATE OFFICE

The local registrar will forward daily (except Friday) to the state registrar all original vital
records filed with the county office (s. 382.005(3), F.S.); failure to file records daily places
the county health department in a situation of noncompliance.
    1. The records should be arranged in order by date of event;
    2. These records are to be accompanied by the appropriate transmittal form DH 758A,
       B or C; a separate transmittal form should be prepared for each event, i.e. one for
       births, one for deaths and one for fetal deaths;
    3. Birth paternity replacements, along with the original, should be noted on the DH
       758A transmittal in the appropriate space;
    4. Permanent replacement records, for previously filed temporary death records,
       transmitted by themselves should be accompanied by transmittal form 758B. The
       appropriate box should indicate the number of records in the shipment.
    5. In those instances where no records have been registered for a month, use the
       appropriate DH 758 form for each event in which there has been no activity,
       indicating “0"; this negative report should be submitted by the 7th day of the following
       month.
    6. It is strongly recommended that a traceable form of overnight delivery be used when
       sending original records to the state office, such as FedEx, UPS, etc.

The following are procedures for handling of the shipment of records before they are
inserted into the mailing envelope:
    1. Records must be in date order;
    2. A sequential Record Tracking Number (RTN) is to be applied to each document:
        a. Birth record – middle upper left margin, next to the tabs, “Father/Informant;”
        b. Death record – lower left margin, below the prompt, “Part II;”
        c. Fetal Death record – middle left margin, next to the tab, “Burial;”
        d. If using the local file number as the RTN, the number should be placed in the
            usual space for Local File Number (LFN) on the record.
        e. The first batch processed for the event (birth, death, fetal death) might be, for
            example #1-#50;
        f. The second batch would pick up with the next sequential number for that event; if
            26 records are sent, the numbers would be #51-#77;
    3. If a sequential number is used as a LFN, this number can be used as the RTN if that
        number is applied just before mailing and the records are sorted in ascending date
        order.
        a. If this can be done, there is no need for a second number to be applied;
        b. If this cannot be done, a separate RTN must be applied as indicated above.
    4. Complete the appropriate transmittal form for the batch of records with the range of
        numbers included in the batch (DH 758 A, B or C).
        a. List the beginning and ending RTN or LFNs associated with each batch;
        b. Enter the total number of records.
    5. Photocopy the transmittal and each record (full copy, normal size) within the batch --
        this is in additional to the LR copies;
        a. Store the copies and transmittal until you receive confirmation from the state
            office that the shipment has been received;
        b. Once the batch is reconciled, you should shred the copies of the records.




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                                    CHAPTER 3 – REVIEW & TRANSMITTAL OF RECORDS




Receipt at state office:
   1. Date-stamp each transmittal upon receipt;
   2. “Count down” and reconcile the range of numbers against those reported;
   3. The state office will notify the local office immediately of any missing records and
       indicate the record(s) missing by their RTN; these discrepancies will be noted in the
       comments area of the transmittal receipt. The CDR must be able to identify a given
       RTN should there be an inquiry from the state office.
   4. When all transmittals have been reconciled for the day, they are entered into the
       database by Current Registration staff;
   5. An email notice is sent to the designated county office staff;
   6. The state office will maintain the paper copies of the transmittals for the period
       required by department retention policy, which is 3 years.

Reconciling shipment at county office
   1. The contact person(s) in the local office will receive an email receipt for the
      transmittal within 2 days of the state office receiving it;
   2. These emails must be checked every day;
   3. The local office must match their email receipt with the copy of the transmittal sent to
      reconcile the shipment;
   4. E-mailed transmittal receipts received by the local office should be kept for a period
      of 3 years as required by the department retention policy;
   5. If a shipment appears to have not been received at the state office, the CDR must
      immediately:
      a. Notify the Local Registrar and county security officer;
      b. Call Current Registration (do not leave a message, call until you reach a person);
      c. Email quality assurance, once the calls have been made;
      d. An incident report, DH 1152 must be completed, detailing the facts in accordance
           with DOHP 5-6-01. A copy of the incident report must be sent to Ken Jones,
           Deputy State Registrar.

                                   SPECIAL REQUESTS FOR RECORDS

When necessary, records that are not yet received in the state office will be requested from
the local registrar. When such a request is received, the local registrar is asked to prepare
the customary local copy of the record, along with the appropriate transmittal (DH 758), and
immediately forward the original to the state office at once.

In the event the record has not yet reached the local registrar's office, either the hospital
staff, midwife, funeral director, or physician should be contacted and the record requested
immediately.

                                    QUERY ON INCOMPLETE RECORDS

Birth, death and fetal death records received in the state office lacking required information
will be queried. The query may be in the form of an email, a phone call, or both. The CDR
should respond with answers to the queries within 24 hours, but no later than two business
days.

Once the information has been obtained, the CDR should contact current registration, either
the birth or death unit, with the information. The CDR will be directed by state office staff to
make a notation to the local file copy. The procedure calls for the copy to be stamped


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                                    CHAPTER 3 – REVIEW & TRANSMITTAL OF RECORDS




“amended” in the top left margin, placing a small checkmark beside it. The item being
added/completed should also have a small checkmark beside it, linking the two.

Do not stamp births at the top when the amendment is for the Administrative Use Only
section or for the Information for Medical and Health Use Only section. For these items, the
stamp should be placed on the bottom of the record or on the back of the record, just as the
state office does.

    BIRTH, DEATH, OR FETAL DEATH THAT OCCURS IN ANOTHER REGISTRATION
                             DISTRICT/COUNTY

Local registrars are not to accept for filing birth, death records or burial-transit permits, or
fetal death records for events that did not occur in their county. If the registrar is in receipt of
a record for an event that occurred in another Florida county, the appropriate county should
be notified immediately of the error and the record sent to that county. The preparer of the
record should be notified as to the proper filing procedures.




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                                                CHAPTER 4 – SAFETY PAPER




                                    CHAPTER 4 - SAFETY PAPER

In 1987, it became mandatory that all certified copies be issued on safety paper. This paper
is obtained through the state office and there are strict guidelines as to how the shipment of
safety paper is handled upon receipt in the county vital statistics office. Authorized
personnel only, preferably vital statistics staff, must make receipt. Prompt return of the
required paperwork, completed in its entirety, ensures the county and the state office that
there are no discrepancies in the shipment. Discrepancies must be noted on the receipt
form and forwarded to the state office. If discrepancies are noted after the paper has been
receipted, the Chief Deputy Registrar must notify the state office immediately.

Storage of paper must be in a secure area, with limited access. Paper must be used in
numerical sequence. A Security Paper Usage Report, by audit control number, must be
maintained for each paper type and printer/copier used. Voided audit control numbers
appear on the Security Paper Usage Report as well as on the Void Report, along with the
date, who voided, and the reason for the void. The voided paper must be shredded
immediately. A physical inventory of sealed cartons and packages on hand must be made
on a monthly basis with this fact being noted in the Inventory Log. The log must be
maintained for five fiscal years.

Destruction of obsolete or unusable safety paper must be accounted for on the Inventory
Log. The purchasing agent at the state office, who coordinates all safety paper orders, must
be notified of any intent to destroy safety paper. A Destruction Report, DH 1084, must be
completed and the original kept on file with other safety paper reports within the CHD. A
signed copy must be filed with the state office purchasing agent. An accounting of the
numbers must be made in e-Vitals through a DocSequence. The numbers must be entered
as voided. This procedure does not include the required steps of Voiding “spoiled” paper
while in daily use. That procedure is outlined further in this chapter.

Documentation is necessary in accounting for all safety paper. Should there be a breach in
security and certain numbers appear on fraudulently issued documents, it becomes easier
to trace the source of the paper, and to whom it was issued. With daily accounting of safety
paper, any break in numerical sequence becomes evident immediately.

                                                         ORDERING

     1. Safety paper can only be ordered through headquarters in Jacksonville;
     2. Safety paper cannot be ordered via the SIMS system;
     3. Safety paper is ordered by the box only; it is not ordered by the package. If a box is
        too much for a county office, they should contact surrounding counties to work out a
        transfer of paper. In this instance, the transaction must be recorded on the Inventory
        Log and a Transfer of Paper form completed.
     4. Quantities of safety paper must not reach such levels that emergency orders are
        required. Due to processing requirements, there must be adequate time for filling the
        orders.
     5. Requisitions for safety paper have to be ordered on DH Form 1370H, Supply
        Requisition Management System, Supply Requisition. Blocks 3-15 must be




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                                                CHAPTER 4 – SAFETY PAPER




         completed. This form is now available electronically. The CDR completes the form
         and emails to the state office purchasing agent.
     6. Once the requisition is received at the state office, it is checked for accuracy and
         discrepancies noted;
     7. The state office does not have the authority to disburse funds on county health
         department organizational codes.
     8. If the requisition is correct, purchasing will log the request into the computer, assign
         case numbers and sheet numbers;
     9. DH Form 1234, Receipt for Pre-Numbered Forms will be prepared and forwarded
         along with the order to the warehouse;
     10. Warehouse turnaround:
         a. Orders cannot be faxed to the warehouse due to the DH 1234 being attached;
         b. Once forwarded from headquarters, it takes two work days for the order to reach
             the warehouse in Tallahassee;
         c. Once the warehouse receives the order, they are required to fill it within 24
             hours;
         d. All safety paper orders are shipped overnight delivery; six cartons or less are
             shipped via DHL; more that six cartons are shipped via Benton;
         e. Upon shipment:
                 1). Warehouse sends an email notification to the CDR on when to expect the
                      shipment, and copies state office purchasing agent;
                 2). CDR should forward email to all prospective receivers named in the Letter
                      of Authorization;
                 3). If CDR does not receive shipment by that date, the CDR should
                      immediately email the warehouse and copy the state office purchasing
                      agent;
         f. The day after shipping, the warehouse faxes state office purchasing agent a copy
             of the issue document with tracking numbers attached. This allows the review of
             when the shipment was received and who actually received and signed for it.
         g. Warehouse will not ship paper on Fridays due to no one being available for
             receipt on Saturdays;
         h. The issue document and DH Form 1234 will be attached to the outside of one of
             the cartons;
         i. Upon receipt at the county office, remove these documents and proceed with
             paper verification.

REMINDER: Supplies must not be allowed to get so low that the order becomes an
emergency. Supplies must be monitored and there must be an established re-order mark,
based on normal county usage, at which point a new order is submitted in sufficient time for
normal processing.

                             VERIFICATION UPON RECEIPT OF SHIPMENT

To ensure all paper is accounted for, it is imperative the person receiving the paper (i.e. Vital
Statistics personnel, purchasing staff, or whoever receives) verifies the paper immediately
upon receipt. NOTE: Any discrepancies must be reported immediately. See detailed
instructions in section entitled, “DISCREPANCY/INCIDENT REPORTING.”

     1. Upon initial receipt:




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                                                CHAPTER 4 – SAFETY PAPER




          a. The original DH 1234 will be attached to the outside of one of the boxes in the
               shipment, along with the issue document. Copies of the DH 1234 will be
               attached to any additional boxes.
          b. Count all boxes to ensure shipment is complete;
          c. Verify box numbers and audit control numbers listed on the Receipt of Pre-
               numbered Forms, DH form 1234 with those shown on the outside of the boxes –
               these items must match;
          d. Check for broken security tape on the box; this tape must be intact;
     2.   Open each box and verify contents
          a. Verify that all packets are sealed;
          b. Verify the numbers on top of each sealed packet in the box against the numbers
               listed on the outside of the box and on the DH 1234 (do not open the sealed
               packet until actually using the paper);
     3.   Completing the Receipt for Pre-Numbered Forms, DH 1234 -- Anyone receiving
          safety paper orders must be designated in writing to do so. A copy of the Letter of
          Authorization must be forwarded to the Office of Vital Statistics, ATTN: Purchasing.
          a. Enter the date the shipment was received;
          b. Print your name and title;
          c. Sign your name. The signature on this form certifies that the order has been
               verified and everything is correct;
          d. Enter the statement, “No discrepancies noted” if there are none;
          e. You must immediately fax a copy of the completed DH 1234 to the state
               office; this is the copy that will be maintained by the state office in their file;
          f. The yellow copy of this form is the CHD’s copy and the required record of receipt
               of safety paper. For auditing purposes, it must be retained for five fiscal years.
     4.   Place all boxes in secure storage immediately after verification of shipment; boxes
          of safety paper must be stored in such a manner as to allow for use in sequential
          order of audit control numbers;
     5.   If, for some reason, you receive a partial shipment, proceed as follows:
          a. At the bottom of the DH 1234, in the space provided for discrepancies, indicate
               what has and has not been received, e.g. received 2 of 4 boxes;
          b. Fax the DH 1234 immediately to the state office purchasing agent;
          c. Upon receipt of the balance of the order, verify receipt of all that should have
               been included, again, on the county copy, in the space provided for
               discrepancies, e.g. received 2 boxes, balance of order of 4 boxes;
          d. Fax the updated DH 1234 to the state office.
     6.   If a CHD does not comply with the requirements stated:
          a. CHD will be contacted for verification and correct completion of the form;
          b. Incidents of noncompliance with these important procedures will be reported to
               the deputy state registrar and the local registrar for action;
          c. CDR will be copied of any such notice.

NOTE: As each sealed package is opened the CDR should countdown each sheet of paper
to be sure all numbers are accounted for. If there is a discrepancy, follow the procedure for
Discrepancy/Incident Reporting.




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                                                CHAPTER 4 – SAFETY PAPER




                                  DISCREPANCY/INCIDENT REPORTING

1. Reporting procedures:
   a. Any discrepancy in the shipment must be immediately reported to:
      1). DOH warehouse at (850) 414-8086;
      2). Vital Statistics Administrative Services (purchasing) at (904) 359-6900 extension
           1060, 1069, 1058, or 1059;
      3). Local Registrar;
      4). Email all of the above, along with your quality assurance field representative,
           once the calls have been made.
   b. An incident report, DH 1152 must be completed, detailing the facts in accordance
      with DOHP 5-6-01. A copy of the incident report must be sent to Ken Jones, Deputy
      State Registrar.
   c. The discrepancy must also be noted on the county’s yellow copy of the DH 1234.
2. Any discrepancies noted after returning the DH 1234 to Jacksonville, e.g. when paper is
   assigned to staff for daily use:
   a. Must be immediately reported by telephone to Vital Statistics Administrative Services
      (purchasing) at (904) 359-6900 extension 1060, 1069, 1058, or 1059
   b. An incident report, DH 1152, must be completed detailing the facts; fax to QA field
      representative at (904) 359-6911;
   c. Must be noted on the county’s yellow copy; include action taken.
3. The following are reportable incidents:
   b. Incomplete shipment – any boxes missing in the shipment as listed on DH 1234;
   c. Any boxes in the shipment are damaged;
   d. The security tape is broken;
   e. Any packet of paper inside the box is not properly sealed (torn, broken or unsealed);
   f. Paper/packet is damaged in any way;
   g. Audit control numbers on individual packets are not sequential or do not match those
      shown on DH 1234;
   h. Other suspected discrepancy/incident.
4. Any paper deemed unusable/damaged must be accounted for in e-Vitals by doing a
   DocSequence and voiding the number or range of numbers, thus making a permanent
   record of the damaged paper.

                                                  REQUIRED LOGS

1.   Inventory Log (manual log)
2.   Safety Paper Usage Report (maintained electronically in e-Vitals);
3.   Void Report (printed from e-Vitals);
4.   VOIDs are also displayed on the Security Paper Usage Report;
5.   Receipt for Pre-numbered Forms, DH 1234;
6.   Transfer of Paper , DH 1941, when applicable (noted on Inventory Log);
7.   Destruction Report, DH 1084, if applicable (noted on Inventory Log);
8.   Retention of manual logs is for five fiscal years;
9.   All deputies must be familiar with log procedures.




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                                                CHAPTER 4 – SAFETY PAPER




                                     ACCOUNTING FOR USE OF PAPER

1. Safety Paper Usage Report, – a record of issues is recorded in e-Vitals under the
   Safety Paper Usage Report. The CDR must be assured that there is no breach in
   security and that all numbers have been duly issued.
       a. A daily accounting of safety paper usage must be maintained;
       b. It is not necessary to maintain hard copies; the report is electronically maintained
           in e-Vitals and can be printed at any time, should there be a need.
       c. If there is a missing number in any sequence
           1). Research the transaction to verify what happened to that number
           2). If it was a VOID that was entered incorrectly:
               a). Go to the original transaction and enter the VOID properly;
               b). Follow procedure on the handling of VOIDs;
               c). If the paper was damaged during the issuance process, the number still
                     needs to be entered and accounted for within that original transaction; the
                     new number, replacing the damaged number, must be entered in a
                     separate “replacement” DocTracking
2. Audit Control Number (AC#) must be on all applications and copies of same;
3. A separate report must be reviewed and monitored for each printer and each safety
   paper type (DH 1946, 8 ½ x 11 and DH 1947, 8 ½ x 14.
4. VOIDS
       a. Voided or “spoiled” paper must be accounted for daily;
       b. Voided safety paper audit control numbers appear on the Void Report in e-Vitals;
       c. Voided numbers also appear sequentially on the Safety Paper Usage Report;
           1.) DO NOT delete the voided number from the system;
           2.) They must appear in the left hand column;
           3.) They must appear on the same line as the original transaction;
       d. Void reports must be printed and maintained for five fiscal years;
       e. Write “Void” across spoiled paper;
           1.) Cut/tear off the audit control number and bottom left seal
           2.) Put number in envelope and staple envelope to the day’s Void Report OR
           3.) Paste/tape to the Void Report;
       e. Voided paper must be destroyed daily:
           1.) At the time the number is voided OR
           2.) Paper can accumulate (in a secure fashion, such as in a locked box) and be
               destroyed at the end of the work day;
           3.) Method of destruction must be entered to the log, e.g. personal shredder,
               locked shred box (usually a private company that picks up contents and
               shreds on site), or whatever method is used;
       f. Some of the reasons for a VOID might be:
           1.) Copied upside down;
           2.) Too dark or too light;
           3.) Wrong record copied;
           4.) Paper damaged in copier/printer, etc.
5. Inventory of paper on hand – a regular inventory of all safety paper must be performed
   and recorded on the Inventory Log. It must be done at the same time each month, at a
   time to be determined by the CDR. This inventory includes:
       a. All paper stored within the vital statistics unit;
       b. Paper stored for daily use in the issuance of certifications;
       c. Any paper stored within the building to which the CDR has access;



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                                                CHAPTER 4 – SAFETY PAPER




          d. It also includes any paper stored off site in a warehouse or other storage facility.
             If stored off-site, either the CDR must physically perform the inventory, or the
             person in charge of that location must perform the inventory and provide a copy
             to the CDR for posting to the Inventory Log.

     A separate Inventory Log must be maintained for each type of safety paper used in the
     county office. Inventory must be entered to the Inventory Log in the appropriate columns
     as outlined below:
         a. Range of Numbers inventoried;
         b. Date inventory is done – it is suggested the inventory be performed either before
             the start of business or at the close of business to get a “clean count”;
         c. Name of who performed the inventory;
         d. Status of inventory:
             1). Used
                 a) The range of audit control numbers used for issuance of certifications
                     since the last inventory should be entered to the Inventory Log;
                 b) The last number used each month will determine what the first number for
                     the following month should be. This number must be verified.
                 c) The actual accounting of these numbers is reflected on the e-Vitals
                     Security Paper Usage Report;
             2). Open
                 a) Enter the range of numbers of all open reams or “loose” paper;
                 b) This is the “working” paper used for daily certifications;
                 c) You must actually “countdown” each sheet of paper to be sure all is
                     accounted for;
             3). Sealed
                 a) Unopened reams; cellophane wrap is intact;
                 b) Verify first and last numbers and enter range to log;
             4). Transferred – a detailed accounting of transferred paper must be
                 documented on the Transfer of Paper, Form DH 1941
                 a) The range of numbers of any paper transferred to or from another county
                     must be noted on the Inventory Log;
                 b) The range of numbers of any paper transferred to or from a satellite office
                     must be noted on the Inventory Log.
             5). Destroyed – when a range of numbers is deemed unusable or obsolete, that
                 range must be noted to the Inventory Log with a note in the Comment field as
                 to the reason.

                                              TRANSFER OF PAPER

1. Paper transferred must be accounted for on the Transfer of Paper, Form DH 1941,
   whether it is to a satellite office or a simple loaning of paper to another county;
       a. The main office or ordering county must initiate the transfer of paper;
       b. The transfer must be noted on the Inventory Log;
       c. Each branch must maintain the same logs as the main office for all receipts and
          issues;
2. DH 1941 must be completed with each party completing the appropriate section of the
   form, depending on whether transferring or receiving.
       a. The original is returned to the transferring county;
       b. A copy must be maintained in the receiving county;



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                                                CHAPTER 4 – SAFETY PAPER




3. A copy of the DH 1941 should be kept with all other safety paper information as
   documentation;
4. If courier or other form of traceable delivery method is used for the transfer, a copy of the
   receipt must also be maintained with the log.

                                         STORAGE OF SAFETY PAPER

1. Safety paper must be stored within the vital statistics office and not left sitting in
   hallways, on the floor, or other areas that are not secure;
2. Paper should be stored in a locked file cabinet, closet, or safe;
3. Paper must not be left in view of clients or other passersby;
4. Use safety paper in the order in which it was received; storage must be arranged so that
   it is issued in numerical sequence;
5. Paper must be removed from copiers and printers each night unless both are in a locked
   closet or other secure storage unit. It is not sufficient that the office is locked each
   evening. There needs to be an additional level of security;
6. Opened paper intended for daily use must be secure at all times during the workday;
7. Remember, safety paper is valuable. It must be safeguarded at all times and access
   must be limited to only those persons with a need to handle the paper.




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                                        CHAPTER 5 – ISSUANCE and CERTIFICATIONS




                    CHAPTER 5 – ISSUANCE and CERTIFICATIONS

Local and chief deputy registrars are authorized to issue certifications of Florida vital records
through the e-Vitals system, pursuant to s. 382.025, F.S. Procedures for issuance through
e-Vitals are covered in the e-Vitals Manual. Birth certifications are issued directly from the
system. Certified copies of death and fetal death records may be issued for those events
occurring in the county. These certifications are issued from either the original death
certificate at the time the record is filed, or at a later date, from the local file copy. Fees for
these services may be collected and retained. It is at the discretion of the local registrar to
waive certain fees within the county vital statistics office. It is suggested that fee waivers be
delineated in a written policy authorized by the local registrar. Fees should be collected
upon issuance, unless a prepayment schedule has been established with the CHD.

The standard application, either form DH 1960 or 1961, must be utilized in all county vital
statistics offices. To avoid misunderstanding, the applicant should complete the application
form. All supporting documentation, such as drivers’ license number, badge number, ID
number, court order, notarized affidavit, power of attorney, etc. must be recorded on the
AFS in e-Vitals and noted on the application. If copies of documentation are made, they
should be maintained in a secure area, along with the application for one fiscal year.

The following statement should be posted for public view within the vital statistics office:
“To obtain and use a Florida vital record under false or fraudulent purposes is a third-
degree felony, punishable by the terms and conditions set forth in Florida Statutes”.

Request from unauthorized person -- When an applicant, other than an authorized/eligible
person as outlined in statute, requests a certification of a confidential vital record, the
Affidavit to Release a Birth Certificate, DH 1958 or Affidavit to Release Cause of Death, DH
1959 should be completed by someone who is authorized to receive that certification.
    1. This notarized affidavit, along with the applicant’s photo identification (ID), must
        accompany the completed application.
    2. The affidavit presented for the purpose of obtaining a certification of a vital record is
        valid for that issuance only and must be the original document; faxed copies are not
        normally acceptable.
    3. Whiteout, strikethroughs, or alteration of any kind is unacceptable.
    4. An updated affidavit must be presented for each subsequent issuance.
    5. A notarized statement from an authorized person can be utilized if the applicant does
        not have access to the aforementioned affidavit. The statement must contain all
        information required in the affidavit in order to be acceptable and must be the original
        document; faxed copies are not normally acceptable.

A durable power of attorney:
   1. Must be notarized;
   2. Has no expiration date, unless so stated;
   3. Ceases upon the death of the person (the “grantor”) initiating the document. The
       CDR should ask if grantor is still alive.
   4. CDR should contact the state office Client Services Unit for assistance on any power
       of attorney that is questionable.




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                                        CHAPTER 5 – ISSUANCE and CERTIFICATIONS




A court order:
   1. Is a mandate, direction or command authoritatively given by the court and signed by
       a judge.
   2. May be presented as proof of authorization for an individual to receive a certification
       that is not otherwise available to them.
   3. Unless so stated in the court order, there is no expiration of the order. If there is
       mention of a subsequent court date, the CDR should ask for the most recent court
       order.

The local registrar must make every effort to ensure certifications are provided to only those
individuals authorized to receive them as specified in law. The procedures outlined below
are to assist the registrar in determining proper eligibility.

                           EXTENSION OF CREDIT FOR CERTIFIED COPIES

Sections 382.025(1)(a) and (2)(a), F.S. provide for the issuance of vital records to those so
entitled upon the “receipt of a request and payment of the fee…”. County vital statistics
offices must not extend credit to anyone. All certifications must be paid for at or before the
time of request unless arrangements have been made with governmental agencies for
billing or journal transfers.

To facilitate issuance of certifications of death certificates to funeral homes, the CDR may
establish a pre-paid funeral home account with the funeral home that is drawn against for
each certification request. The e-Vitals manual has specific instructions as to how to
establish pre-paid accounts for external customers. If desired, this option should be
discussed with the business manager as a way to accommodate funeral homes.

                                     HOW TO ISSUE CERTIFIED COPIES

All certifications are to be issued on safety paper as mandated by law. Once the applicant’s
eligibility has been established, the certification can be made. The process for tracking
safety paper audit control numbers is outlined in detail in the e-Vitals Manual and will not be
covered in this document.

Ideally, there should be a dedicated printer used only for photocopy certifications. This
reduces the chances of lost or unaccounted for sheets of safety paper. Paper can be
loaded in the morning and unloaded in the evening. If a dedicated printer is not available,
the registrar should take the needed paper to and from the copier with each transaction,
eliminating the possibility of other users printing onto the safety paper. It should never be
left in the paper tray.

When issuing a birth certification, the registrar should always issue from e-Vitals for those
years available. Certifications from e-Vitals contain the signature of the State Registrar; it is
not necessary for the local registrar to co-sign.

If there is a need to issue from the local file copy, a client specifically needs the “book copy”:
     1. e-Vitals must be checked before issuance for any impediment to printing, such as
         an Alerts Message or an entry under the Flags Tab.
     2. County local file copy must be checked against the state database to ensure there
         have been no changes. There could be an amendment pending on the record; if so,
         contact the Amendment Unit at ext. 9005.


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Some records require specific instructions on how to print:
  1. Record with an amendment attached may or may not require two pages.
  2. Birth record with exceptionally long name, requires the preparer to put additional
      names on the back of the record. This requires the issuance of a two page
      certification
  3. Death record with more than one AKA requires that additional names be listed on the
      back of the record. The name field on the front should indicate “additional AKAs on
      back of record”. This will require a two page certification.

Once the copy has been printed:
   1. Certification must show it has been duly issued by the registrar. Ideally, the CDR
       should sign, but deputies may also sign.
   2. Signatures on certifications should be original signatures unless the signature has
       been registered with the Secretary of State. The signature facsimile (see Registrar’s
       Signature, Chapter 3) usually includes the CDR signature, title, county name, and a
       blank for Date Issued.
   3. Date issued must be entered onto the certification, usually to the right of the CDR’s
       signature.


                                          FORMS OF IDENTIFICATION

Identification (ID) is required for all requests for certifications of confidential vital records, i.e.
birth records and death records with cause of death, whether the request is walk-in or mail-
in. That identification must be in the form of a valid/unexpired photo ID in order to
determine the applicant is, in fact, the person they purport to be. The ID must be intact, in
one piece, not torn or in more than one piece. If the mail request does not include the
proper photo ID, the request must be returned to the applicant.

     1. Primary types of valid Photo ID (first four should be posted for the public):
        a. Motor vehicle operator’s license;
        b. State ID card, issued by Department of Motor Vehicles;
        c. Passport;
        d. Military ID, DD Form 2
                1). Active has green background
                2). Retired has blue background
                3). White Common Access Card
        e. Military Dependent ID, active or retired, DD 1173;
        f. Learner’s/instruction Driver’s Permit, if over 18 years of age;
        g. Resident Alien Card, Form 1-551 (permanent resident card) -- ID card issued by
            US Department of Justice- Immigration and Naturalization;
        h. Inmate ID card issued on or after January 1, 1991, by Florida Department of
            Corrections (inmate still in custody of the department);
        i. Inmate ID issued by US Department of Justice (inmate still in custody of the
            department);
        j. If just released from penal institution, client should have a letter from institution or
            prison ID; for possible photo and identifying information, CDR can check
            Department of Correction website: http://www.dc.state.fl.us/AppCommon/
        k. Pilot’s License
        l. Concealed Weapons License


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     2. Secondary Types of valid ID – must have a minimum of two of the following; must be
        valid/unexpired:
        a. Car Registration – must be valid; cannot be used with any other car related
            documentation;
        b. Consular Report of Birth Abroad of a Citizen of the USA, FS 240;
        c. Employment Photo ID with notarized statement from employer indicating they are
            currently employed;
        d. School photo ID with notarized statement from school indicating they are
            currently enrolled;
        e. Credit/debit card with photo
        f. Health insurance card;
        g. Life insurance policy;
        h. US Military Discharge papers, DD 214;
        i. US Selective Service card if through the school system;

NOTE: Sometimes the CDR has to go to extraordinary lengths to assist the client in
producing identification. The following suggestions are for CDR use only and not to be
posted for the public. They are guidelines set down to assist the CDR and offer some
suggestions when none of the above types of ID are readily available. Three or more of the
suggestions below may help to identify the client in unusual circumstances when no regular
form of ID is available:
    1. Motor vehicle operator’s license if it provides a description rather than a photo;
    2. Employment ID that provides a description rather than a photo;
    3. Applicant can provide a list of brothers and sisters that can be verified in e-Vitals;
    4. Voter registration card;
    5. Social security card;
    6. WIC, Medicaid, or other social services form or identification. If client or client’s child
         (in cases of illegal alien who has no valid ID) is receiving services through one of the
         CHD programs, their case worker can assist them in obtaining the birth certification;
    7. Bill or other piece of mail addressed to applicant at the address he/she is providing;
    8. Fishing or hunting license;
    9. Someone has lost all form of ID, purse is stolen, lost in fire or some other type loss:
         a. The CDR should try to work with the client to see what they can provide in way of
             information about their family that can be verified through e-Vitals or local file
             copies to help determine they are who they purport to be;
         b. If ID is stolen, the CDR must ask for a copy of the police report for verification;
         c. If lost ID is Florida Drivers’ License or Florida ID, the applicant can apply to the
             Department of Motor Vehicles for a replacement (there is a fee for this service).
If applicant can produce none of the above, the information cannot be verified or the CDR is
unsure of the acceptability of the ID provided, the CDR should contact the state office for
assistance.




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                                                    BIRTH RECORD

Except for birth records over 100 years old, which are not under seal pursuant to court
order, all birth records are confidential and exempt from the provisions of s. 119.071(1) F.S.
Certified copies of the original birth certificate, a new or amended certificate, or affidavits
thereof, are confidential and exempt from the provisions of s. 119.07(1) and, upon receipt of
a request and payment of the fee prescribed in s. 382.0255, F.S., shall be issued only as
authorized by the department and in the form prescribed by the department.

Valid Photo Identification (ID) is required for all applicants requesting a certification
of a birth record.

Below are guidelines for issuance of birth records:
   1. “To the registrant, if of legal age…”
      a. Registrant -- the child named on the record; must provide photo ID;
      b. If there is no name listed for the child and
          1). Applicant’s ID confirms identity (it should indicate the sex and date of birth in
              order for registrar to cross reference with the birth record);
          2). Applicant can give all other information regarding parentage, place of birth, or
              other pertinent information, then the registrar may release the certification;
          3). The registrar should recommend the applicant contact the state office to have
              their name added to the record through the proper amendment procedure;
          4). If there is any doubt, applicant should be referred to state office for
              assistance.
      c. Legal age
          1). 18 years of age or
          2). Married, if under 18 (must show copy of marriage record and a photo ID) or
          3). A minor who has been emancipated by a court order (must show copy of
              court order and a photo ID).
   2. “To the registrant’s parent, guardian, or other legal representative”
      a. Parent
          1). Persons named on the birth record as mother and/or father;
          2). Father not named on the birth record, but applicant has a certified court order
              stating he is the father (must show copy of court order);
          3). Foster parent must have letter or statement from Department of Children and
              Families or their contracted agent, that they, the foster parent, are acting in
              that capacity;
          4). Stepparent must have notarized affidavit from one of the parents listed on the
              birth record authorizing Vital Statistics to issue to him/her.
          5). Mother/father is deceased and surviving parent remarries and subsequently
              dies:
                   a). If the natural parent did not have a will and no executor or
                       administrator is named, the stepparent then becomes the legal
                       representative of the estate and can order and receive minor
                       child(ren)’s birth record;
                   b). A copy of the marriage record to the natural parent and the death
                       record of that parent is required for proof of relationship;
          6). Mother or father listed on record can provide a notarized affidavit authorizing
              Vital Statistics to issue child(ren)’s birth record, by name, to bearer of letter,
              by name. This could be a grandparent, neighbor, or friend. Statement must



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                 be specific. There is an affidavit, available from the CDR or the vitals
                 website, for this purpose.
          b. Guardian
             1). Must show court order (a photocopy of the court order is acceptable);
             2). Power of attorney executed by one of the listed parents has no expiration
                 date, unless so stated in the power of attorney or the parent is deceased;
             3). Statement or letter from Department of Children and Families or Social
                 Security Administration that the person acting as guardian is receiving
                 benefits in the child’s name;
             4). If stepparent, final judgment of divorce states that child (by name) is to
                 remain in the stepparent’s home and he/ she is primary caregiver;
          c. To Other Legal Representative
             1). Attorney or law firm hired by an authorized person -- she/he must state on the
                 application/letter who they represent and that person’s relationship to the
                 registrant (they must represent an authorized person) and provide their bar or
                 license number.
             2). Individual with written authorization, in the form of the Affidavit to Release a
                 Birth Certificate (DH 1958), from an authorized person. A notarized
                 statement can be used if the statement contains all the information required
                 in the affidavit.
             3). Military Recruiter -- With the proper authorization and completed application,
                 a certification can be issued to the recruiter. The recruiter should complete
                 the application, providing the necessary information, and submit along with
                 the notarized release from the recruit. The following are acceptable forms of
                 release, one of which must accompany the completed application:
                 a). Recruit should complete the standard affidavit, authorizing release of the
                      record to the named recruiter; the Affidavit to Release a Birth Certificate,
                      DH 1958 7/03, can be downloaded from the website:
                      http://www.doh.state.fl.us/planning_eval/vital_statistics/index.html
                 b). Recruit can use the military release, Standard Form 86, authorizing the
                      release of information, as long as the form has been notarized;
                 c). If the recruiter provides a notarized signed release from the recruit,
                      authorizing the recruiter to receive the birth record, the record can be
                      released to the named recruiter;
                      NOTE: A general release authorizing release of records concerning
                      education, employment, medical history, etc. is not enough to obtain the
                      birth record; it must be more specific.
                 d). If the recruit is less than 18 years of age, the parent listed on the record
                      must authorize the release of the record. Once entered into military
                      service, the under-age recruit becomes emancipated, and, for future
                      requests, is entitled to obtain his own birth record without parental
                      approval.
                 e). Neither the state office nor the county office is authorized to provide
                      telephone verification to the recruiter.
                 f). CHD can no longer provide verification on the recruiter’s DD Form 372.
                      In order to maintain control over what type of information leaves our
                      offices, a certification on trackable safety paper must be issued.
                 g). The recruiter is not authorized to obtain a copy of the recruit’s child(ren)’s
                      birth record or those of any other family member unless the above
                      mentioned affidavit is completed and authorizes this transaction.



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             4). In the case of an infant being placed for adoption, the attorney appointed by
                 the court as intermediary for the adoption proceedings; she/he must state on
                 the application/letter their bar or license number and who they represent;
             5). Guardian ad Litem is a special guardian, appointed by the court in which a
                 particular litigation is pending, to represent a minor child in that particular
                 litigation; he/she needs to present a copy of the court paper appointing them
                 as such;
     3. “Upon receipt of the registrant’s death record, to the registrant’s spouse or to the
        registrant’s child, grandchild, or sibling, if of legal age, or to the legal representative
        of any of such person…”
        a. Registrant’s death record -- Usually a certified copy, however, a copy is
             acceptable if you can see evidence that it is a copy of a certified copy;
        b. Registrant’s spouse -- Can easily be verified by checking spouse’s name on
             death record. If no name is stated on the death record and status indicates
             “never married” or “married,” ask for proof of marriage. If status is “divorced” or
             another person is named as surviving spouse, refer client to Client Services Unit
             at the state office.
        c. Registrant’s child, grandchild, or sibling – applicant must provide a photo ID;
        d. When issued, the decedent’s birth record should indicate, “deceased;” if not,
             contact state office and fax copy of death record provided, so system can be
             properly updated to reflect deceased status. Once updated, record can be
             issued.
        e. Legal representative -- of an authorized person;
             a.) Must provide written documentation/affidavit from authorized person;
             b.) If an attorney, he/she must state on the application/letter who they represent
                 (must be an authorized person) and provide their bar or license number.
     4. “To a law enforcement agency for official purposes…” – Request should be on
        agency letterhead, stating it is for official investigation. It is not necessary to state
        the specific official purpose. If someone presents an official badge, a copy of the
        badge should be made and attached to the application or the badge number noted
        on the application. If the specific law enforcement agency does not allow copying of
        official badges, the badge must be presented for viewing. The Internal Notes section
        of the AFS must indicate “badge presented”.
        a. Border Patrol;
        b. FBI;
        c. FDLE;
        d. Highway Patrol;
        e. Probation and Parole;
        f. Sheriff/Police;
        g. State Attorney -- if the request is in the form of a subpoena, refer to those
             specific instructions at the end of this chapter;
     5. “To any agency of the state or the United States for official purposes upon approval
        of the department…” -- Request should be on agency letterhead, stating it is for
        official purposes. It should include the reason such as: agency needs for
        determining eligibility, or the state has taken custody of the child, etc. If someone
        presents an official badge, a copy of the badge should be made and attached to the
        application or the badge number noted on the application.
        a. Department of Health;
        b. HUD;
        c. Social Security;
        d. Veterans Affairs;


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        e. Department of Children and Families, Family Safety Program -- The county
            health departments are to furnish to the Department of Children and Families
            (DCF), or their contracted agent, two certified copies for children in DCF custody,
            at no charge, for court related protective services custody actions.
                1). The copies are to be stamped “For Official Use Only”;
                2). E-vitals should indicate applicant was DCF;
                3). All state and county fees are to be waived for DCF for this specific
                    instance only; it is a local decision as to whether or not fees will be
                    waived under other circumstances;
                4). The only people entitled to these copies are
                    a). DCF caseworkers
                    b). Community based care providers acting as agents of DCF,
                    c). Dependent court personnel
                    d). Child’s current caretaker that are licensed foster parents or group care
                         facilities;
                5). All of these individuals must submit to the vital statistics
                    identification/credentials and signed custody orders along with an
                    application for the birth record before receiving certifications;
                6). If the reason for the certification is for inclusion as a file copy, the CDR
                    should explain that Chapter 382 states the birth record is confidential and
                    that they (the other agency) are responsible for the proper storage and
                    destruction of the record while in their possession and they are not to
                    provide a copy to the birth or foster parent.
     4. “Upon order of any court of competent jurisdiction…” – A court order is signed by a
        judge. A subpoena is not the same as a court order; an attorney or deputy clerk of
        court usually signs a subpoena.
     5. “To any person if the birth record is over 100 years old and not under seal pursuant
        to court order…” -- If the record is over 100 years old, no ID is required; no
        relationship need exist between registrant and applicant; no death record required.
        These are “open records.”

                            OTHER RECORDS (DEATH AND FETAL DEATH)

Certifications of death and fetal death records without cause of death are open records and
are available to anyone; no ID is necessary. The department shall authorize the issuance of
a certified copy of all or part of any death or fetal death certificate, excluding that portion
which is confidential and exempt from the provisions of s. 119.07(1) F.S., as provided under
s. 382.008, F.S., to any person requesting it upon receipt of a request and payment of the
fee.

Valid Photo Identification (ID) is required for all applicants (unless exception is so
noted) requesting a certification of the death or fetal death certificate, which includes
the confidential portions (cause of death and related items).

Below are guidelines for issuance of a certification of the death or fetal death certificate,
which includes the confidential portions (cause of death and related items):
   1. “To the registrant’s spouse or parent, or to the registrant’s child, grandchild, or sibling
       if of legal age…”
       a. Spouse
       b. Parent
       c. Child


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        d. Grandchild
        e. Sibling
     2. “… or to any person who provides a will that has been executed pursuant to
        s. 732.502, F.S., insurance policy, or other document that demonstrates his or her
        interest in the estate of the registrant…”
        a. Will executed pursuant to s. 731.502, F.S. – means handwritten or properly
            prepared document that is signed by the registrant at the bottom and witnessed
            by one other person or signed in the presence of the registrant and witnessed by
            two other persons; requires a photo ID;
        b. Insurance policy -- must name the applicant as beneficiary of the policy. May be
            in the form of a copy of the policy or a letter from the insurance provider stating
            the applicant is a beneficiary of the registrant’s insurance policy; requires a photo
            ID;
        c. Viaticals
            1). Companies that loan terminally ill persons monies, using their insurance
                 policy as collateral;
            2). Must have documentation that the insurance policy was signed over at the
                 direction of the registrant;
            3). Documentation should show that the insurer (insurance company) has
                 accepted the reassignment from the listed beneficiary to the viatical
                 company.
        d. Other document – Executor or administrator of the estate - must provide copy of
            letter of administration as well as a photo ID.
        e. Any person:
            1). Funeral director, as a legal representative of an authorized person may
                 provide their professional license number in lieu of photo ID;
            2). Attorney representing any of the above named authorized applicants – may
                 provide bar/professional license number in lieu of photo ID
                 (s.64V-1.0131(3d) F.A.C.).
            3). Applicant must have a notarized affidavit signed by authorized person,
                 directing Vital Statistics to issue to someone else, such as neighbor, cousin,
                 friend, doctor or other named person.
            2). “To any agency of the state or local government of the United States for
                 official purposes upon approval of the department…” -- request should be on
                 agency letterhead, stating it is “for official investigation.” The officer’s badge
                 number must be noted on the application or copied for the file. If the specific
                 law enforcement agency does not allow copying of official badges, the badge
                 must be presented for viewing. The Internal Notes section of the AFS must
                 indicate “badge presented”.
                 a). FBI
                 b). FDLE
                 c). Highway Patrol
                 d). Local police or sheriff
                 e). Correctional institution – if copy is needed for a mortality review death
                      investigation, along with the application, they must include letterhead
                      stationery with their specific request and why they need cause of death.
                 f). Department of Children and Families
                 g). Department of Health
                 h). State Attorney -- if the request is in the form of a subpoena, refer to those
                      specific instructions at the end of this chapter;
                 i). Social Security


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     6. “Upon order of any court of competent jurisdiction…” -- a court order is signed by a
        judge. A subpoena is not the same as a court order; an attorney or deputy clerk of
        court usually signs a subpoena.
     7. “To any person if the death record is over 50 years old and not under seal pursuant
        to court order…” -- If the record is over 50 years old, no ID is required; no
        relationship need exist between registrant and applicant. These are “open records.”

                                          TELEPHONE VERIFICATIONS

Because you cannot be sure who you are talking to, phone verification should not be done.
The following is a guideline for such requests:
   1. Births - no phone verification.
   2. Death - no phone verification. If a search reveals another county has the record on
        file, you may (this is up to you) tell them you do not have it on file, but give them the
        county, the CDR name & phone number OR you can tell them to contact the state
        office.
   3. Other state agencies, such as state attorney or law enforcement - no phone
        verification. If they need the information, they can complete an application and a
        trackable certified copy can be issued. Whether or not you charge for this service is
        a county decision. For the most part, the state office charges everyone.

     CERTIFICATE OF BIRTH RESULTING IN A STILLBIRTH – (KATHERINE’S LAW)

Section 382.0085, Florida Statutes, allows for the creation and issuance of a special
certification for fetal deaths. A Certificate of Birth Resulting in Stillbirth is created and issued
upon the parent’s request. Subsequent to the initial request, the certificate of Birth Resulting
in Stillbirth becomes available as a public record. This issuance comes from the state office
only and there must already be a fetal death certificate on file. The certification is not
considered proof of a live birth and copies are available from 1947 to the present. An
informational brochure, How to Apply for a Florida Certificate of Birth Resulting in Stillbirth, is
available to the funeral director when meeting with families. The CDR should keep a supply
on hand to provide area funeral homes.

Client requests for this service must be on the Application for Florida Certificate of Birth
Resulting in Stillbirth and directed to the state office, Client Services Unit.

                                              EMANCIPATED MINOR

An emancipated minor can obtain a certification of their own birth record. One can become
emancipated in a number of ways, such as being a member of the armed forces, if they are
married (must be able to provide proof of marriage), or have obtained court adjudication
(Ch. 743, F.S.).

                   APOSTILLE OR EXEMPLIFIED COPIES OF VITAL RECORDS

Apostille or exemplified copies are usually needed when dealing with vital records and
foreign countries. Foreign embassies or consulates oftentimes require apostille copies of
vital records. A funeral director may need an apostille death certificate to ship a body
outside the U.S. Someone may need an apostille birth, death, marriage or dissolution of
marriage if moving to a foreign country.



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An apostille or exemplified copy of a vital record includes a statement signed by the
Secretary of State attesting that the state registrar is the custodian of the vital records of this
state as shown in the official records of the Department of State. Inquiries for such copies
should be referred to the state vital statistics office.

The signature of the state registrar is registered with the Department of State. The
certification must be one that is issued from the state office. Accordingly, a certification
issued from a county vital statistics office is invalid for the purposes of obtaining an apostille
or exemplified copy. If the county receives a request from the state office to send the
original record for such an issuance, please act promptly; this is a time sensitive issue.

The fee for an apostille or exemplified copy certified by the Secretary of State is $10.00 for
each document submitted (check must be made payable to the "Secretary of State"). This
fee is in addition to the $29.00 fee for a birth record and $25.00 fee for all other records
(check made payable to the Office of Vital Statistics) required by the state office for search,
certification, processing, and forwarding of the certified copy to the Secretary of State.

There is a brochure explaining the apostille and what it is. Contact the warehouse to order
copies for county health department customers. If further information is needed, contact
Client Services at the state office.

                                    OTHER COPIES OF VITAL RECORDS

There are times when the CDR is asked to provide copies of certain vital records to other
Department of Health entities, such as Healthy Start, HIV/Aids, & FIMR.

If your county is an EBRS county where birth records are filed by hospitals online, then you
do not provide Healthy Start with copies; the Healthy Start Coordinator accesses the data
through the department’s e-vault system. If your hospitals still file paper birth records, you
must still provide Healthy Start with a “plain” copy of the necessary birth records.

If the Aids Coordinator asks for a copy of a death record, they can be granted access to the
e-vault system (contact Ray Herz at the state office), you can make the copy through the
evault system, or you can make a plain copy of the death record. If FIMR needs a copy of
the birth or death record, the copies should be made through the evault system.

                                                  KEYING ERRORS

When issuing a vital record and the applicant, who is still in the county office, indicates there
is a spelling error in the name, it is possible that when the record was keyed, an error was
made. In these instances, the registrar should utilize the Key Error/Flag form, which can be
found on the department Intranet website.

The form must be completed in its entirety and faxed to the Search Unit at the number listed
on the form. Be sure to include a phone number should you need to be contacted. Due to
the volume, you are asked not to call the state office, but to fax the form to the number
shown on the form. Allow sufficient time for receipt and locating the record. If the hard copy
of the form shows a different spelling, the record will be updated in the system and you will
be notified when it is OK to print. If the hard copy indicates the same spelling as the system,
the applicant should be advised to contact the Amendments/Corrections Unit for assistance
in making the change to the correct spelling.


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If the applicant calls some time after receiving the certification and indicates there is an error
in the name, the CDR should complete the Key Error form and fax to the state office. The
state office, once determining that it was a key error, can fix the error and contact the county
to let them know of the correction. The CDR can contact the applicant to let them know they
can pick up the record and they should be asked to return the original certification in order to
receive the new one. The CDR should go back to the original transaction and update with
the Replacement Copy information once the client comes back in for the record. The
original certification must be VOIDED according to procedure.

If the record was completed by an EBRS (electronic birth registration system) hospital, the
applicant will have to contact the Amendment Unit to determine how to proceed.

                                    RECORDS WITH ALERT MESSAGES

When issuing a certification, the registrar must always issue from e-Vitals for those years
available unless a photocopy/book copy has been specifically requested. If there is a need
to issue from the local file copy, e-Vitals must be checked before issuance. The local file
copy must also be checked against what is in the database. This ensures that the client
receives the most accurate record should there have been any amendments to the original
record. There is also the possibility that printing of the record has been suppressed for
some purpose. Issuance of a record could subject the county and/or the state office to legal
repercussions should unauthorized issuance occur.

When a document is scanned there is a statement on the bottom of the screen that says
“Image Present”. It means the record has been scanned, and the image of that record is in
the system. This is primarily for state office use and does not prevent printing of the record.

Once the CDR has located the record in question, there is an “Alert” box in the upper right
corner. If there is an “Alert Message”, you must check to see if it is OK to print. The CDR
must also check the “Flags” tab which indicates if there is any flag on the record and what
type of flag is present. Some flags will suppress print others will not. The registrar is asked
to utilize the Key Error/Flag form to indicate the type of flag and fax to the number indicated.

Below are the Alert Messages as shown on the screen (printing suppressed):
        Amendment in Process – Refer Client to State Office, 904-359-6900, X9001
        Child is Missing! - Contact FDLE, 1-888-356-4774
        Director Indicator - Contact State Office
        Fee Due - Contact State Office, Key Error/Flag Form
        Putative Father – Contact State Office, 904-359-6900, X9001
        Record Review - Contact State Office, Key Error/Flag Form
Below are the Alert Messages (printing not suppressed) and what you are instructed to do
in that message:
        Person is Deceased! – Check ID to be sure person ordering is not the decedent. If it
        is the decedent making the request, contact state office utilizing the Key Error/Flag
        form; do not print until OK is received.
        Delay Amend – Evidence Will Not Print – OK to print/issue

If you get any inquiry where there is question as to what type of amendment has occurred,
you should refer them to the state office.



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                                        CHAPTER 5 – ISSUANCE and CERTIFICATIONS




DO NOT TELL A PARENT, REGISTRANT, OR APPLICANT THAT THE RECORD HAS
BEEN FLAGGED! Simply advise that you are having difficulty printing the record and need
to contact the state office.

                                                MISSING CHILDREN

Chapter 937.024, F.S. requires the Office of Vital Statistics to suppress printing of birth
records of missing children and contact the Missing Children’s Clearinghouse when anyone
applies for such a record. This is a cooperative arrangement with the Florida Department of
Law Enforcement (FDLE) and every effort must be made to see that procedures are
followed.

In the Alert Message field, this message appears, “Child is Missing! Contact FDLE
(1-888-356-4774). If the local registrar receives a request for a record with an FDLE
flag/Alert Message, the registrar must:
    1. Contact FDLE Clearinghouse to ascertain status, i.e., should the suppress print
        indicator remain. Is the child still missing or has the child been returned to the
        family?
    2. If the child is no longer missing, FDLE will immediately notify the state office and the
        suppress print indictor will be removed to allow printing; FDLE will let the county
        know when they are able to print;
    3. If the child is still missing, the Clearinghouse will ask questions to determine where
        the request originated; the Clearinghouse will subsequently notify appropriate law
        enforcement handling the case;
    4. If the Clearinghouse instructs the registrar to call local law enforcement, the registrar
        should state that according to s. 382.355 and 937.024, F.S., it is the responsibility of
        the Clearinghouse to contact law enforcement. As an arm of law enforcement and to
        ensure a rapid response, the Clearinghouse was delegated this responsibility.
    5. The local authorities may or may not follow-up with the registrar;
    6. Under no circumstances should the registrar relay information to the applicant that
        the child is listed as missing and there is a suppress print indicator on the child’s
        record or there is anything unusual. Any activity with FDLE must be kept
        confidential.

The state office sends the CHD a bi-weekly printout of new names added to the FDLE list of
missing children. This printout includes an attachment showing the county, and the child’s
name and date of birth. If the county has no missing children, either current or prior, the
county name does not appear on the list, thus the CDR does not receive a copy of the list. If
the CHD receives such a list with their county listed, the registrar must pull the local file copy
of the birth record and return it to the state office, to the attention of Darlene Newmans.
Remember, all FDLE information is confidential.




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                                        CHAPTER 5 – ISSUANCE and CERTIFICATIONS




                                                      SUBPOENAS

A subpoena asking for a certification of a vital record should normally (see D below) be
forwarded to the Office of Vital Statistics, as the official custodian of records. This will
ensure that the client gets the most current information, including any recent amendment or
information that may be contained in a pending file that may be in our facility. Process as
follows:
     A. Send an email to the state office, to the attention of the Marilyn Nevado,
         Administrative Assistant to Ken Jones, Deputy State Registrar, advising of receipt of
         the document and that you will fax (904/359-6931) and mail the hard copy. That
         email address is: marilyn_nevado@doh.state.fl.us Mail the hard copy to:
                  Office of Vital Statistics
                  Attn: Marilyn Nevado
                  P.O. Box 210
                  Jacksonville, FL 32231-0042
        Follow-up immediately with the hard copy and mark the outside of the envelope in the
        lower left corner – URGENT.
     B. The CDR should keep a copy for their file and, if time permits, write to the client
         advising them that the document has been forwarded to the Office of Vital Statistics
         for handling. If time is critical, i.e., a hearing or required attendance to produce
         documents is within the next few days, the CDR should call the client in lieu of the
         letter. Indicate in your file that you spoke to the client and advised of action taken.
     C. A log is kept on these documents and tracks who within the state office is handling
         the request. Therefore, should you need to follow-up on the issue with our office,
         contact Marilyn Nevado at (904) 359-6900 ext. 1002.
     D. If the county attorney reviews the subpoena and is comfortable with the local office
         providing the certification, the subpoena does not need to be forwarded to the state
         office. In these instances, the CDR must verify with the state office that there have
         been no amendments/changes to the record that might not have been forwarded to
         the county. Once the county local file copy has been deemed acceptable, CDR may
         go ahead and issue.

Because this is a court issue, we cannot overemphasize the importance of your
acting immediately when you receive this type of document. Anytime you have any
questions in this regard, please do not hesitate to contact the state office




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                           CHAPTER 6 – PENALTIES FOR VIOLATION OF VITAL STATISTICS LAWS




                     CHAPTER 6 - PENALTIES FOR VIOLATION OF
                            VITAL STATISTICS LAWS

Pursuant to s. 382.026, F.S., persons who willfully make or alter any record, except in
accordance with the provisions of the vital statistics laws, or who willfully furnish false or
fraudulent information affecting any record required by this law, are guilty of a third degree
felony and are subject to a fine of not more than $1000 per day or imprisonment not to
exceed 60 days, or both.

Those who knowingly transport or accept for transport, inter or otherwise dispose of a dead
body without an accompanying burial-transit permit issued in accordance with the provisions
of the vital statistics laws, are subject to a fine of not more than $1000 or imprisonment not
to exceed 60 days, or both.

Except where a different penalty is provided, any person who violates any of the provisions
of the vital statistics laws, rules, or regulations, or who neglects or refuses to perform any of
the duties imposed upon him by law, shall be subject to a fine of not more than $1000, or
imprisonment not to exceed 60 days, or both. In addition to any other sanction or penalty
allowed by law, the department may impose a fine not to exceed $1000 for each violation of
sections 382.006, 382.007, 382.008, or 382.013 Florida Statute (F.S.) or Florida
Administrative Code 64V-1.

                                         TIMELY FILING OF RECORDS

Birth records must be filed within 5 calendar days of birth as stated in s. 382.013, F.S.
Failure to file records on time is a direct violation of vital statistics law.

Death and fetal death records must be filed within 5 calendar days of death, or, if an
extension of time is granted, an additional 5 business days are allowed as stated in
s. 382.008(1), F.S. If the death requires a further extension of time, beyond the extension
granted on the permit, the funeral director must provide written justification to the registrar.
This written justification is in the form of the Death Registration Delay Report, DH 1355,
which must be filed by the funeral director, detailing the efforts to obtain a completed record
from the physician.

                          DEATH REGISTRATION DELAY REPORT, DH 1355

The Death Registration Delay Report (DRD), VS 1355 (can be found on website), is to be
used by the funeral director when a physician or medical examiner has not completed the
cause of death on the death record within 72 hours of receipt from the funeral director (s.
382.008(3) or 382.011(2) F.S.). All of the funeral director's attempts to obtain the death
record from the physician/medical examiner must be documented on this form.

The DRD report should only be used when a death record cannot be filed on time, due to
the physician or medical examiner delaying the record. It should not be used to justify
delays resulting from the use of the mail.

A death record must not be held up for filing if personal information is missing. Any personal
information not available at the time of filing should be entered as "unknown" or



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                           CHAPTER 6 – PENALTIES FOR VIOLATION OF VITAL STATISTICS LAWS




"unobtainable" on the death record and the record must be submitted within the required
statutory time limit. The death record can be amended at a later date should the personal
information become available.

                                                  NONCOMPLIANCE

Local registrars must notify any hospital, midwife, funeral director, or physician/medical
examiner who fails to file records in a timely manner, as required in
s. 382.008 and 382.013, F.S. They must notify the state office of those who continue to be
noncompliant. The registrar must document all efforts made to get a record filed.

Chief Deputy Registrars must set up a file system for noncompliance. It is suggested that a
file for each hospital, birthing center, midwife, medical examiner office and funeral home
located in your county be created. Files should also be created for midwives and funeral
homes that work in your county but are located elsewhere. When a problem arises with a
physician in your county, a noncompliance file should be created for that physician.

A record of all phone calls, notes, copies of returned records and noncompliance letters
must be kept in this file. When noncompliance continues, the quality assurance field
representative will want to review the file and determine the appropriate action to take.

Birth Facility/Midwife File
    1. For each hospital, birthing center and midwife;
    2. Face sheet with:
        a. Facility name and address;
        b. CEO;
        c. Health Information Management director or Labor and Delivery director
             (whichever is responsible for birth records) and phone number;
        d. Name of Birth Registrar and phone number;
        e. Method and frequency of delivery (mail or courier, daily or Monday, Wednesday
             and Friday, etc.);
        f. Notation of any training (can have separate sheet);
    3. Calendar for recording number of records returned each day, which must include
        number of records filed for that month/week to determine the extent of the problem, if
        any;
    4. Copies of all correspondence related to facility;
    5. Copies of records returned with problem fields highlighted;
    6. Copy of performance records received from state office that includes the percentage
        of records filed on time;
    7. Note sheet:
        a. Documentation of specific problems -- conversations, phone calls, visits, etc.;
        b. Any other information that might be considered pertinent to facility performance;
    8. CDR must keep close tabs on performance and keep Quality Assurance informed of
        any ongoing performance issues that may necessitate further action;
    9. QA will review files at each field visit to assess performance.




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                           CHAPTER 6 – PENALTIES FOR VIOLATION OF VITAL STATISTICS LAWS




Letters of Noncompliance should be constructed as follows:
    1. All written notifications of noncompliance should be directed to a specific person, by
        name. The letter should never be directed to “Dear Administrator” or Dear Funeral
        Director;”
    2. If the letter is directed to a funeral director, the funeral director in charge of the
        establishment should be copied, if it is not the addressee;
    3. The letter should be mailed “Certified Mail” to ensure receipt. “CERTIFIED MAIL”
        should be included at the top of the letter;
    4. Font size and style should conform with department standard of Arial 11;
    5. If the letter is directed to someone outside of the CDR’s county, a copy should be
        mailed to the CDR of the county where the funeral home is located;
    6. A copy should also be forwarded to Quality Assurance.
    7. Letters should include:
        a. Specifics about the CDR’s attempts to correct the problem;
        b. Dates and names of contacts spoken to at funeral home;
        c. Identify the type of problem;
        d. If timeliness is the issue, the date the record was due and the number of days
            late should be included.
    8. Sample letters of noncompliance are included in the attachments of this manual;
    9. Sample letter should be adapted to meet the specific need; it is not intended to be
        copied verbatim. It is important that the letter state the exact problem, such as,
        “death record was due on May 10, but was not filed until June 11, making the record
        20 days late.” This allows the funeral director to see the enormity of the problem.

The state office monitors hospital filing times for birth records. The CDR receives a monthly
listing via email and is required to forward it to each hospital so they are aware of their
compliance status. The hospital must maintain a 90% compliance rate. If there is an
unusual situation where filing times are not met, such as the birth registrar left and new one
is in training, the CDR must notify the state office. Otherwise, when falling below 90%, the
CDR must follow-up with the hospital to obtain a written action plan as to how they are going
to correct the problem. This action plan should be relayed to the state office.

The state office monitors funeral home noncompliance based on the noncompliance letters
sent by CDRs. Repeated instances of noncompliance are followed up by quality assurance
and possible administrative action will take place.




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                                                  CHAPTER 7 – ADOPTIONS




                                        CHAPTER 7 - ADOPTIONS

Requests concerning the procedures for adoptions and paternity actions must be referred to
the state vital statistics office. The state registrar is mandated under Florida law to protect
the confidentiality of the records of these children, as well as other parties to adoption and
paternity actions, from unnecessary disclosure of their original status. Information
concerning children to be adopted received from clerks of circuit court, child placement
agencies, county health departments, attending physicians, attorneys, and others is
correlated with the original record.

Birth notification form letters and other correspondence with the natural parents are
terminated and measures are taken to ensure that the natural parents may not subsequently
obtain a copy of the new (adoptive) birth record.

To help in preventing inadvertent disclosure of private and confidential information,
registrars are asked to advise the state registrar at once of the prospective adoption of any
Florida-born child of which they have knowledge. Such notification must be made by writing
“adoption” in light pencil on the reverse of the original birth record.

It is recommended that a local file copy not be made for prospective adoptions.

                    BIRTH RECORDS FOLLOWING ADOPTION PROCEEDINGS

Upon receipt of the prescribed report of adoption or other necessary information on a child
born in Florida, the state registrar makes available a record with the new information for the
child. This record bears the same file number as the original record. All names and
statistical particulars entered on the new record refer to the adoptive parents, but nothing on
the record indicates these parents as being adoptive. The original record, together with
related papers, are sealed and retained. The local registrar's copy of the old record is
recalled.

It is important to note that not only the record, but any reference to the record such as index
card, microfilm or other image must also be deleted from the local vital statistics office. It is
crucial that these documents be pulled from the county files immediately upon request from
the state office to prevent accidental issuance of a document that should be sealed by an
order of the court.

Any inquiry for a sealed record as a result of adoption must be referred to the state office,
Adoption Unit.

                                 FLORIDA PUTATIVE FATHER REGISTRY

The purpose of the registry is to permit a man alleging to be the biological father of a child to
assert his parentage, independent of the mother, and preserve his rights as a parent.

A Florida Putative Father Registry Claim, per statute, is done without the consent or
involvement of the mother. The registry is where the putative father claim is filed and
recorded. His name is not added to the birth record. The state office suppresses printing of
a birth record that has been linked to a putative father claim and should the county office get



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                                                  CHAPTER 7 – ADOPTIONS




a request for a record that has a claim linked to it, you will receive an Alert Message to
contact the state office Adoption Unit.

Putative father information is confidential and only certain parties, as defined in
s. 63.0541, F.S., are eligible to search the registry. It is critical that county vital statistics
staff do not divulge that such a claim has been filed. If the person applying for the record is
eligible, the CDR contacts the state office, the “suppress print” indicator will be temporarily
removed so that the certification can be issued. If the party requesting the record is one of
the eligible persons the law authorizes release of putative father information, we will want to
advise them of the claim that is on file and for further information, contact the state office.

Putative father information differs from An Acknowledgment of Paternity, which can be done
at the hospital at the time of a child's birth or subsequently by filing a DH Form 432,
(Acknowledgment of Paternity) with the state office. This type of action requires both the
mother and father to agree to the paternity acknowledgement and adds the father's name to
the birth record.

The CDR must keep the applicable Putative Father forms on hand (see list of forms in
Chapter 2). The information cards are available in English, Spanish and Creole. Please be
sure to display them where they are readily accessible by your customers.

Questions on the Putative Father Registry should be referred to the state office Adoption
Unit or refer to the website at
http://www.doh.state.fl.us/planning_eval/vital_statistics/Putative.htm




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                           CHAPTER 8 – BIRTHS OCCURRING OUTSIDE A FACILITY, HOME BIRTHS




            CHAPTER 8 - BIRTH OCCURRING OUTSIDE A FACILITY,
                              (HOME BIRTH)

When knowledge of a non-hospital birth or home delivery comes to the attention of a chief
deputy registrar, a record of live birth is to be completed and, in most cases, registered in
the county where the birth occurred, provided that the first birthday has not been reached. If
the first birthday has passed, the parent should contact the state office to obtain procedures
for filing directly with that office.

Section 382.013(1) (b, c), F.S., indicates who shall prepare and register births that occur
outside a facility. In order to register a birth that occurred outside a facility, it is necessary
to:
    1. Verify the birth did occur;
    2. It occurred at the place and on the date reported;
    3. The child for whom the record is being prepared is, in fact, the child of the person to
       be shown as the mother.
    4. Proof that such a birth did occur to the mother listed on the record must be
       documented by the CDR before the record is accepted for registration.
    5. Section 64V-1.006, F.A.C. provides instructions for obtaining proper documentation
       in such cases.

To expedite the registering of the birth:
   1. There can be a home visit by an official of the county health department to verify the
      birth or
   2. The parents may bring the child to the county vital statistics office at a pre-appointed
      time (the CDR must be contacted for an appointment).
   3. It will be necessary for the parents to provide a valid signature/picture form of
      identification, such as a driver’s license or identification card issued by the state of
      Florida or any other state, and their social security card.
   4. It will be necessary to provide proof of pregnancy.

To assist the CDR in such cases, the following has been prepared to help in verifying the
birth did occur; it occurred at the place and on the date reported; and the baby for whom that
record was prepared is, in fact, the baby of the person who is shown as the mother. Copies
of a sample worksheet and sample affidavit are provided in the attachments of this manual.

Non-Hospital Birth Attended by Mother, Father, or Other individual

The CDR should contact the county nursing director or lead nurse in the county health
department to establish facts of birth if validation is needed. If the family is not known, the
nursing director will initiate a follow-up to secure information to validate the birth and
determine the health status of the mother and baby. If the birth occurred within six weeks of
the requested certification, with the permission of the family, a home visit may be made by
the public health nurse.

The following suggestions may be used to help verify the facts:
   1. Investigation of prenatal care: statement as to when, where, and by whom was
        mother examined? Did examination verify pregnancy?
   2. Review of clinical records, if available;



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                           CHAPTER 8 – BIRTHS OCCURRING OUTSIDE A FACILITY, HOME BIRTHS




     3. Postpartum exam by CHD nurse or doctor, with the permission of the mother;
     4. CHD nurse interview with mom;
     5. Verification from employer of one or both parents stating the employer was aware of
        the pregnancy;
     6. Documentation from social service or community agency aware of the pregnancy;
     7. Statement from day care personnel if there are other children in day care;
     8. Statement from clergy or neighbors.

If the mother received no prenatal care, or documentation of such is unavailable, a
statement, preferably notarized, is required from two witnesses verifying the pregnancy.
These witnesses must also provide a valid photo ID.

If the mother did receive prenatal care, she should provide a statement from the physician or
midwife to document that, and a statement from one additional witness, verifying the
pregnancy.

These statements may be completed by witnesses at the time of the appointment (photo
identification is required), or the witnesses may complete the statement and return it to the
county office by mail. All documentation must be completed and submitted prior to
completion of the birth certificate.

If the birth occurred at home and mother and child are brought to the hospital within three
days after a home delivery, the hospital should prepare the record with what facts are
available. The record should then be filed in the county where the delivery occurred.

If the CDR has questions or concerns, contact the state office.




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                                     CHAPTER 9 – OTHER BIRTH REGISTRATION ISSUES




               CHAPTER 9 - OTHER BIRTH REGISTRATION ISSUES

                     HOSPITALS RESPONSIBLE FOR FILING BIRTH RECORD

Within five calendar days after the date of each birth (e.g. child is born today, day one
begins tomorrow), the hospital administrator or designated representative of the facility
where the birth occurred is responsible for filing the birth record. It is most important that
hospital staff is familiar with the vital statistics laws and regulations on birth registration. The
administrator or designated representative of the facility where the birth occurred must
certify to the fact of birth by signature before the birth record is acceptable for registration.
Physicians in attendance at institutional births may also sign birth records, but timely
registration must still be observed. Specifically, the hospital is charged with responsibility to:

     1. Collect and record demographic and medical information as required on the birth
        record;
     2. Prepare a correct and legible record, making certain that each item on the record is
        completed before certifying the record;
     3. Any “unusual” entry on the record should have explanation on back of record;
     4. Have the mother or the father sign the record after it has been completed. If
        signature is not obtainable, type mother’s name in item 22 with an explanation on the
        back of the record.
     5. If mother is unmarried and wishes to have the father listed on the record, the hospital
        should make every effort to assist in the completion of the paternity acknowledgment
        on the front of the record, keeping in mind that the record cannot be held beyond the
        five days, waiting for the father to sign;
     6. If mother and child are brought to the hospital immediately after a home delivery, the
        hospital should prepare the record with what facts are available. The record should
        then be filed in the county where the delivery occurred.
     7. Register the record with the proper local registrar within the five-day time specified.

                                       NON-INSTITUTIONAL DELIVERY

If the birth is non-institutional, the attendant at such birth is required to register a complete
and accurate birth certificate with the local registrar of the county in which birth occurred.

           BIRTH OCCURRING IN ANOTHER REGISTRATION DISTRICT (COUNTY)

Local registrars are not to accept nor forward to the state office records for births not
occurring in the registrar's county. If the registrar is in receipt of a birth certificate for a birth
that occurred in another Florida county, the appropriate county must be notified immediately
of the error and the record sent to that county.




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                                     CHAPTER 9 – OTHER BIRTH REGISTRATION ISSUES




                                         INFANT BIRTH/DEATH MATCH

Infant mortality is one of the factors considered when assessing the overall public health of a
community. In order to tabulate the Infant Mortality Rate for a county, it is imperative that
records are filed and that they are the correct records for the event. The chief deputy
registrar has a key role in this important public health issue.

There are several important steps to be taken when reviewing records for possible infant
deaths:

Reviewing the birth record:
   1. When the county office receives a birth record for a child and the hospital has noted
      that the child is deceased in item 29a, the registrar must:
      a. Note “deceased” in the upper right margin of the back of the original record;
      b. Follow up to see that a death record is filed on the child;
      c. Search your records to verify that a fetal death record has not been filed
           erroneously as well.
   2. If a birth record indicates a birthweight of 500 grams or less and/or very low apgar
      scores, the registrar must:
      a. Check with hospital to see if child is still alive or has died;
      b. If deceased, verify that a death record has been filed;
      c. Search your records to verify that a fetal death has not been filed erroneously.

Reviewing the death record:
   1. Check all death records for infant deaths (less than 1 year of age).
   2. When it is noted that a deceased infant was also born in the same county as noted in
      Birthplace, item 7, the registrar must:
      a. Check their birth records to see if a birth certificate has been filed.
      b. Put a note on the back of the death record to indicate that a birth is on file, and if
          different, include the name under which the birth record is filed.
   3. If no birth record is on file, follow up with the funeral director or hospital to learn the
      circumstances of the birth and contact the appropriate party to get the record filed.
      a. Was it a Live Birth or Fetal Death?
      b. Search your records to verify that a fetal death has not been filed erroneously.
      c. Could the hospital have determined it was a fetal death, but failed to inform the
          funeral home and the wrong form was filed?
      d. Could it have been a fetal death under 20 weeks gestation and therefore no
          record should be filed?
      e. Verify spelling of names of child and of parents to be search was done with
          correct spellings.

Periodic follow-up will be conducted from the state office on those situations where records
are not filed. A prompt response to such inquiries is appreciated. If the county is contacted
by the state office for follow-up on a birth, death, or fetal death record:
    1. CDR must contact the hospital or funeral home to determine the circumstances of
        the birth or death.
    2. CDR must keep in touch with funeral home/hospital and the state office until the
        correct record is filed and the case has been resolved
    3. Once resolved, the record must be forwarded immediately to the state office and
        should have the appropriate LWB (Low Weight Baby) coversheet to identify it. The



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                                     CHAPTER 9 – OTHER BIRTH REGISTRATION ISSUES




          coversheet ensures that the records are properly routed for processing and does not
          become a duplicate record.

Monthly listing -- The monthly listing from the state office of all children who have died prior
to the age of one has been replaced by implementation of the e-vault. The report you
generate from e-vault can be accessed at any time. You still must check for infants who die
in the county and also for infants whose residence is the county. Detailed information on e-
vault is provided below.

     1. For the deaths that occur in your county, you must check to see if the birth also
        occurred in your county:
        a. If so, and you maintain local file copies of births, the CDR must mark the local file
             copy of the birth record of the deceased child;
        b. "DECEASED" must be printed in the upper left margin of the local file copy of the
             birth record so that it appears on any subsequent issuance for that local file copy.
        c. County indices, microfilm copies, and computer databases must also be flagged.
     2. If the death occurred in another county, but the residence indicates your county, you
        should determine if the county of birth is your county and mark your birth copy
        accordingly.
     3. If the residence is your county, but neither the birth nor death occurred in your
        county, you may be asked by the FIMR representative for a copy of the birth and/or
        death record. They can both be printed through the e-vault.

                                             E-VAULT PRINT SYSTEM

Chief Deputy Registrars and deputy registrars have access to a secure Department of
Health (DOH) website called E-Vault Print; the web address is:
                                http://hpe00ws/EVault/EVault.aspx.
This website was constructed for authorized DOH employees only and is provided to enable
greater flexibility in performing your Vital Statistics duties and for program monitoring
activities.

There are three related evault reports available:
         Infant Deaths
         Fetal Deaths
         Very Low Weight Births (< 500 grams) - X-LBW
These reports replace the existing paper reports which had been mailed monthly and
contain data which is already two to three months old. The e-vault reports can be run using
the following three selection criteria:
         County (select either resident or recorded events)
         Month of the event (Jan-Dec, or the full year)
         Event year
All three reports (Infant Death, Fetal Death, and Very Low Weight Birth) contain information
needed to allow for program monitoring and tracking records relative to your specific county.
Both the Infant Death and Very Low Weight Birth reports contain data fields to indicate if the
individual record has been linked to a corresponding birth or death record. These reports
may also prove to be useful in locating an event which has both a Live Birth and a Fetal
Death filed, as well as an event having both a Fetal Death and an Infant Death filed, thus
allowing appropriate intervention on these records.



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Additionally, the site contains links to allow the user to print work copies (non-certified) of
certificates for events of live birth, fetal death and death. The searcher will need to know the
State File Number of the specific record you wish to print (obtainable from e-vitals search or
the three new reports). The individual records may be printed for use in various county and
state activities, such as Healthy Start, FIMR, and other CHD functions.

Remember, these activities are monitored and should only be used as part of your Vital
Statistics activities and functions, in compliance with Chapter 382, Florida Statutes.

                                            ENUMERATION AT BIRTH

The Enumeration at Birth Program is coordinated through the Social Security Administration
(SSA). By the parents requesting on the birth record that a social security number be issued
for a child, the SSA will issue a social security card for the child within 6-8 weeks of the date
of birth. This card will be helpful to the parents in filing taxes, obtaining a passport for the
child, admission to day care programs, school entrance and other programs.

SSA will not mail a social security card to a non-US address, such as a military address or
APO address. In these instances, the parents will have to apply for the number themselves
or provide a US address as the Mother’s Mailing Address when completing the birth record.

NOTE: SSA will not issue a social security number on a deceased or unnamed child. They
will issue a number, but not mail the card to a foreign or military address.

                                            HUSBAND TO BE SHOWN

When the mother of a child is married at the time of birth, she must list her husband as the
father of the child regardless of circumstances. Local registrars are asked to require that
such birth record be completed in accordance with these instructions.

If the husband dies prior to the birth of the child, the husband's information may be entered
on the record in all items related to the father. “Is Mother Married?” item 15, should, indicate
“No.” A notation of “widowed” should be entered in the upper right margin of the back of the
record.

Should a married mother refuse to supply information on her husband because he is not the
biological father of her child, the following statement should be entered across the record in
items 19 and 20: “Mother refuses information on husband.” All other father information
should indicate “Unknown.”

If the mother desires to show anyone other than her husband as father of her child, she
should be advised to institute proceedings in the courts to determine the true facts of
parentage. If the court decrees that the husband is not the father and the child is thus
declared illegitimate, the decree of the court will be followed in filing or changing the birth
record.




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                                   ACKNOWLEDGEMENT OF PATERNITY

A. Paternity Acknowledgement on the front of the birth record -- in situations where the
   mother is unmarried and the father is acknowledging paternity, the acknowledgement on
   the front of the birth record is available for completion in the hospital/birthing center at
   the time of birth. Both the mother and the father’s signatures must be notarized, or
   witnessed by two witnesses, and all items completed in order for the acknowledgement
   to be valid. When using the notary, the preferred method, all rules under the notary
   statute, s. 117.05, F.S., apply. This acknowledgement can only be completed during the
   time the hospital has the original birth record. It cannot be sent to the county office for
   completion.

     Two Witness Option
     When a notary is unavailable or when the father has no acceptable identification, the
     two-witness option can be exercised as allowed in s. 742.10, F.S. The following
     provides details related to the use of two witnesses for the in-hospital paternity
     acknowledgment:
        1. Signature Requirements and Options:
            a. Both parents must sign the acknowledgment.
            b. If either parent is a minor, the minor is encouraged to obtain the consent of
                his or her legal guardian before signing the acknowledgment. However,
                under law, a minor can sign the acknowledgment without the consent of their
                parent or legal guardian.
            c. The mother and father may not witness each other’s signature.
            d. The last name of the parents on the birth certificate and Paternity
                Acknowledgment section must match the signatures. If there is some
                discrepancy in the names, such as the Spanish tradition of two last names,
                but the names are identifiable as the same person listed, then the signature is
                acceptable.
            e. The signature is both an acknowledgment of the information and a verification
                of the information.
        2. When using the two-witness option, there are no statutory requirements related
            to either the witnesses or parents providing identification.
            a. Hospital staff can serve as witnesses and will often be personally known to
                the birth clerk or person that is facilitating the paternity acknowledgment, and
                it can be expected that at other times the parents will provide their own
                witnesses that are not personally known to hospital staff.
            b. Statute does allow minors to acknowledge paternity and have their signatures
                witnessed using this option. However, we encourage the use of a notary
                public in situations involving minors signing legal documents.
            c. If parents provide witnesses that are willing and able, hospital staff cannot
                refuse to facilitate the paternity acknowledgment based upon a lack of
                identification for any of the parties. However, we encourage hospital staff to
                use good judgment when they are themselves serving as witness to parental
                signatures.
            d. If any prospective witness is uncomfortable witnessing any individual
                signature because of the lack of identification, the birth clerk (or other person
                facilitating the paternity acknowledgment) should consider the use of another
                witness, if available or notary public instead.




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The hospital must provide the parents with the information sheet, “What You as a Parent
Must Know before Signing This Acknowledgement”. They should read this information
before signing the Paternity Acknowledgment. Copies of this information sheet can be
found on our website at:
http://www.doh.state.fl.us/planning_eval/vital_statistics/template3.htm

There is also the Florida In-Hospital Paternity Establishment Resource Guide, a Child
Support Enforcement (CSE) document to assist the birth registrar when dealing with in-
hospital paternity issues. A copy of this guide can be found on the department Intranet
website, under Vital Statistics or from the local CSE coordinator.

B. Paternity establishment after birth record is filed:
      1. If, at any time after the birth of a child born to an unmarried mother, the parents
          wish the name of the father, as well as other particulars included on the birth
          record, the local registrar should refer the parents to the state office where a new
          birth record can be filed through the amendment process;
      2. The registrar must keep a supply of the Acknowledgement of Paternity, DH 432,
          and the Application for Amendment to Florida Birth Record, DH 429 form to
          provide to those parents requesting to add a father after the original record has
          been filed;
      3. Once the proper paperwork is filed and accepted, the original record, together
          with any related papers, are retained;
      4. The local registrar's copy of the old record is recalled – it is crucial that these
          documents are pulled from the county files immediately upon request of the state
          office to prevent accidental issuance of a document.

                                                   PLURAL BIRTHS

Multiple births are to be reported on separate records, and each record is to be completed in
the usual manner. If possible, send all multiple birth records together when transmitting to
state office. If not, make note on the back of the record the status of the other sibling(s)
record. The CDR must check with the hospital to see that a record is filed for all siblings in a
multiple birth. If a sibling dies prior to delivery and has not reached 20 weeks gestation, no
record is filed. The CDR must make note of this fact on the other birth record.

The Chief Deputy Registrar must make sure all multiples are accounted for and that
pregnancy history is correct.

Conjoined twins must have a birth record filed for each twin.

                                                     FOUNDLINGS

A birth record must be registered for every child of unknown parentage. The hospital must
file a record for any foundling brought to their facility. This record must show all known or
approximate facts relating to the child. Information concerning the place and circumstances
under which the child was found must be shown. That portion of the birth record relating to
medical and health details must be completed.

The birth record must indicate:
        Last name field – Unknown



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          Date, Location, County, Facility Name - “Found”, along with the appropriate facts
          Mother’s Maiden and Current surnames – Unknown
          Mother Married - Unknown
          Father’s Last Name – Unknown
          All other information must show “Unknown” unless it can be determined.
          Parents’ Signature - “Unavailable”

In the event that a foundling child is subsequently identified to the satisfaction of the state
registrar, the state registrar makes available a record with the new information for the child.
This record bears the same file number as the original record. The record originally
prepared will be sealed and filed, not to be opened except upon receipt of an order of a
court of competent jurisdiction. All local registrar copies of the original record will be recalled
by the state. It is crucial that these documents are pulled from the county files immediately
upon request from the state office, to prevent accidental issuance of a document that is
sealed pursuant to an order of the court.

                                   SAFE HAVEN/SURRENDERED BABIES

The identity of a parent who leaves a newborn infant, seven days old or less, at a hospital or
a fire station, in accordance with s. 383.50 and 383.51, F.S., is confidential and exempt from
the provisions of s. 119.07(1), F.S. Surrendered babies come in two forms, the most
common being the newborn left at a fire station or hospital ; the other when the mother
delivers in a facility, but leaves the child, in effect surrendering the child to the facility.

     1. Newborn dropped off at fire station or hospital; there is nothing known about the facts
        of this birth - the hospital must prepare a birth record for any newborn brought to
        their facility. Items should be completed as follows:
        a. “Unknown” in the name fields – child, mother’s current surname, and father;
        b. Date of birth, item 3, should have the date the newborn was left and “Found” or
            “FND”;
        c. Place Where Birth Occurred, item 7, should have “Unknown” typed to the right of
            the home birth checkbox, do not use the term found in this item;
        d. Facility name, item 8, and City, Town or Location of Birth, item 9, should have the
            address of the fire station or hospital where the newborn was left along with the
            term Found;
        e. County of birth, item 6, should have the county where the newborn was
            abandoned and the term Found.
        f. Mother’s Maiden Name must indicate Unknown in the name field;
        g. All other information must show Unknown.
        h. Signature of Parent should indicate, Unavailable;
        i. Birth registrar should notate name of hospital completing the record and “Safe
            Haven baby” on the back of the record in the upper right margin.

     2. Newborn left at the hospital after delivery; there is information available regarding the
        delivery, but only those items directly related to the baby can be entered; the
        mother’s anonymity must be protected, as outlined in s. 383.50, F.S., none of her
        information can be used In this scenario, the mother just walks away, abandoning
        the baby at the facility. Items should be completed as follows:
            a. “Unknown” in the name fields – child, mother’s current surname, and father;
            b. Complete date, location, county, and facility name according to the facts of
                the birth;


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               c. Mother’s Maiden Name must indicate Unknown in the name field;
               d. Signature of Parent should indicate, Unavailable;
               e. All other items on the record pertaining to the mother and/or father should
                  indicate “unknown”.
               f. Other child related items, items 50 - 55, should be answered according to the
                  information in the child’s medical record;
               g. All other items on the record should indicate “unknown”.
               h. Birth registrar should notate “Safe Haven baby” on the back of the record in
                  the upper right margin.

The CDR must notify the state office immediately of any babies that fall into this category.
Include the name of the hospital, date of event and known circumstances of the birth. The
CDR should note on the back of the record, Safe Haven Baby, if not done so by the birth
registrar.

                                      LATE REGISTRATION OF BIRTHS

Birth registration for children under one year of age may be registered and processed by the
local registrar, using the regular standard birth record and in the same manner as current
records. An explanation for the lateness should be shown in the upper right margin on the
back of the record. In the case of a home (non-institutional) birth, extra precautions must be
taken to prevent fraudulent filings (see chapter on Home Births).

                                           DELAYED BIRTH RECORDS

A fee paid search of state office files must officially determine that the birth of a child
over year of age has never been recorded; then a delayed birth record may be filed if
sufficient evidence can be obtained. This must be done in accordance with procedures set
forth in Florida Statutes and Florida Administrative Code, and an additional processing fee is
required.

Local registrars are not to issue any type of “not found” statement, but should refer the client
to the state office for an official search of state records. If the state search can find no
record, an official “not found” statement will be issued along with instructions for filing a
delayed record.

      BIRTHS THAT OCCURRED IN OTHER STATES, OUTLYING U.S. AREAS, AND
                 OVERSEAS BIRTHS INVOLVING U.S. NATIONALS

The U.S. Public Health Service, Centers for Disease Control, National Center for Health
Statistics (NCHS) maintains information on where to write for information regarding other
states etc. It is available on their Internet website at: cdc.gov/nchswww. This is an
excellent source of information on this subject for use by registrars.

Births occurring overseas involving U.S. nationals may not be registered in the State of
Florida. Inquiries may be referred to the state office (refer to attachments). For a foreign
adoption by a Florida resident, the department will, upon request of the adoptee or the
adopting parent, prepare and file a birth record upon receipt of a certified copy of the
adoption decree (s. 382.017, F.S.).




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                                               BIRTH NOTIFICATION

Notification is sent to parents when the child’s birth record is officially entered into the vital
statistics database and assigned a state file number. This form is mailed approximately 11
or 12 weeks from the date of birth and it informs the parents that a birth record is on file for
the child, and gives the state file number and address of the state office if the parents wish
to purchase a certification.

NOTE: Birth Notifications are not mailed to a foreign or military address.

                                                   HEALTHY START

The Healthy Start Program provides enhanced services to infants that may be at risk during
their first year of life due to health or environmental factors.

The birth record provides the scoring data for Healthy Start to use when determining
eligibility for the program. The mother is asked to sign the Healthy Start Prenatal form,
authorizing the release of the birth information to Healthy Start.

A Healthy Start form must be filed for every birth, regardless of the screening score of the
child or whether or not the parent agrees to participate. The Healthy Start boxes at the top
of the birth record must be completed at the hospital on every record, regardless of Healthy
Start status. Hospitals using the Brookins software to generate the birth certificate can also
generate the Healthy Start form. The Healthy Start scoring is automatically calculated
based on the birth certificate information. The consent checkboxes on the top of the birth
certificate, which are for statistical purposes only, and the consent items on the Healthy
Start form should be consistent. These checkboxes should be completed on every birth
certificate, whether by hand or automatically.

If the hospital is using EBRS, the Healthy Start Coordinator should use the e-vault system to
obtain the Healthy Start form and the birth data needed from the birth record since there is
no paper record or form. Detailed procedures on this process can be obtained from the
Office of Maternal and Child Health in Tallahassee, at (850)245-4465.

For the hospitals still filing paper birth records, the CDR should work with the Healthy Start
Coordinator to determine if they need copies of the birth certificates where the mother has
agreed to screening. If so, these are photocopies and must be stamped “confidential, for
research only”, and it must be understood that no client should be given this copy. The
CDR must receive assurance that these copies will be destroyed once Healthy Start has the
information they need. In some counties, Healthy Start staff arranges to view birth
certificates within the VS office, eliminating concerns about destroying copies once they are
finished. This process should be worked out to the satisfaction of both the CDR and Healthy
Start.

If the residence is Florida, but not your county, the birth photocopy should be provided to
your Healthy Start coordinator who will then send to Healthy Start in the county of residence
OR forwarded to the CDR in the county of residence for their subsequent distribution to their
Healthy Start coordinator.

If an infant subsequently dies, the e-vault system must be accessed for the reports related
to infant deaths. The CDR should provide a copy of the death record to Healthy Start, if


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requested. The death copy can also be printed from the e-vault system. If FIMR needs a
copy of the death record, they should contact the CDR where the death occurred and the
CDR can print the death copy from the e-vault system. If photocopies of records are used
they must be stamped “confidential, for research only”. The Healthy Start coordinator in the
county of residence, if not the same as county of death, should work with their counterpart in
the county of event to obtain the necessary information.

Further information on the Healthy Start Program can be obtained from the Healthy Start
Care Coordinator in the county.

   SURROGATE MOTHER OR GESTATIONAL SURROGACY (S. 382.013, 742.16, F.S.)

The hospital birth registrar should contact the local vital statistics office Chief Deputy
Registrar for assistance in instances of gestational surrogacy.

The Chief Deputy Registrar should contact the state office for guidance on how to proceed
with the completion of the birth record in surrogacy situations.

                             ELECTRONIC BIRTH REGISTRATION SYSTEM

The Electronic Birth Registration System (EBRS) is the mechanism by which births are
registered via the Internet. It is designed to allow a hospital birth registrar to electronically
enter and register a child’s birth record, and capture and store any required signatures. This
registration process eliminates the need for hospitals to forward original hard copy birth
records to county health departments. EBRS streamlines the birth registration process,
making it virtually paperless, improving customer service, and eliminating courier service for
hospitals.

In order for the hospital and state office to ensure a record is filed for every delivery, and
that no fraudulent record is filed, the birth registrar must fax the local county vital statistics
office a labor and delivery log or other form of Reconciliation Report for the CDR to reconcile
against the records entered into the database.

Detailed information on the EBRS system can be found in the EBRS Hospital Manual, found
on the website at: http://www.doh.state.fl.us/planning_eval/vital_statistics/index.html


NOTE: CDR should refer to the Vital Records Registration Handbook, Chapter 3, for
item-by-item instructions for the birth record.




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                                            CHAPTER 10 – DEATH REGISTRATION




                            CHAPTER 10 - DEATH REGISTRATION


      FUNERAL DIRECTOR/DIRECT DISPOSER'S RESPONSIBILITY TO FILE DEATH
                                 RECORD

The funeral director/direct disposer who first assumes custody of the decedent must obtain
the required personal and statistical particulars and present the death certificate to the
attending physician, or to the medical examiner when applicable, for signature and medical
certification of the cause of death. He/she must place on the record the facts relative to
place of burial or other disposition, sign the record, and list his license number and address.
The funeral director/direct disposer must present the completed record to the local registrar
within five calendar days of death (e.g. death occurs today, day one begins tomorrow),
unless an extension of time has been requested.

                                  USE OF THE BURIAL-TRANSIT PERMIT

The burial-transit permit is used for notifying the local vital statistics staff that a death has
occurred in their county. The burial-transit permit is a document in triplicate:

     1. Original/white copy follows the body to place of final disposition and is subsequently
        filed by the sexton/funeral director, within 10 days of receipt, with the county of final
        disposition;
     2. Funeral director/yellow copy is the file copy for the funeral home;
     3. Local registrar/pink copy is filed in the vital statistics office in the county of death.

Another important use of the permit is to act as a tracking device to make sure that the
death record is filed on time. The local registrar must:
   1. Match the pink copy of the burial-transit permit against death records received. This
       process also helps to ensure that duplicate records are not filed.
   2. For all records not received by the date due as shown in Part B (within five calendar
       days of death or within the extension of time granted), an informal investigation must
       be initiated by the local registrar to determine the reasons for the delay;
   3. The pink copy must be used for documenting all efforts by the registrar to obtain the
       record;
   4. The state office must be informed of noncompliance issues regarding persons who
       repeatedly violate this section of the vital statistics law.

Cemeteries, crematories and other places of final disposition are required by
s. 382.007 F.S. to file the white copy of the burial-transit permit in the county where final
disposition occurs and within ten days after final disposition. If the death and final
disposition occur in the same county, both the white copy of the permit and the pink copy of
the permit will be filed in that county. The registrar must match these copies.

When a death occurs in one county and final disposition in another, files must be kept for
both pink copies and white copies of permits in the appropriate county. Retention on burial-
transit permits is three fiscal years.




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                                ISSUANCE OF BURIAL-TRANSIT PERMITS

A burial-transit permit should not be issued until a complete and satisfactory record of death
or fetal death has been filed, unless the funeral director provides adequate assurance that a
complete and satisfactory record will be so registered. This assurance is given by proper
completion of Part A, #5 on the permit, obtaining assurance from the certifier that they will
sign the record. The permit must be obtained within five calendar days of death and must
be submitted to the local registrar within 24 hours of issuance as indicated in the instructions
on the back of the form and required under s.64V-1.011, F.A.C.

There is normally only one permit filed for each decedent, regardless of who handles the
remains or if they are transferred from one establishment to another. If remains are
disinterred at a later date and the original permit is not available, a new permit cannot be
issued.

It is permissible for the subregistrar to fax a copy of the permit to the CDR in order to meet
the statutory requirements for filing of the permit. It is not permissible to hold the permit until
the death certificate is signed unless both are filed at the same time and it is filed within the
prescribed time limits for the permit and death certificate.

Those who knowingly transport or accept for transport, inter or otherwise dispose of a dead
body without an accompanying burial-transit permit issued in accordance with the provisions
of the vital statistics laws, are subject to a fine of not more than $1000 or imprisonment not
to exceed 60 days, or both.

A subregistrar may not be commissioned at more than one establishment, but they may
issue a burial-transit permit to any licensed Florida funeral director, other than himself.
Detailed instructions on the burial transit permit can be found in the Vital Records
Registration Handbook, Chapter 6.

Local registrars may issue burial-transit permits for those deaths that occur in their county
only. When issuing a permit, the registrar must:
    1. Grant an extension of time if so requested;
    2. File the pink copy in the county office (the yellow copy is the funeral director’s copy
       and the white copy accompanies the body);
    3. Local registrars do not have an obligation to issue burial-transit permits outside of
       regular office hours.
    4. Issue the permit, using the funeral home’s next sequential number (to be supplied by
       the requestor at the time of request for permit). This instance is usually for the
       funeral home with a subregistrar who is unavailable at the time the permit is needed.
    5. The local registrar will utilize a county numerical sequence in the following instances:
           a. Medical examiner’s office that does not have a subregistrar;
           b. Out of state funeral establishment;
           c. Hospital acting as funeral director (hospital disposition)
           d. Family member acting as funeral director (“bury your own”);
           e. The number should contain the county number, the year, and the number of
               the permit.
    6. For those establishments who do not have a subregistrar:
           a. The establishment must keep track of their permit numbers and provide their
               next sequential number on the permit when applying;



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               b. If the permit number is missing, the CDR can work with the establishment
                  until they are familiar with the process, but if they continue to omit the
                  number, the CDR will use the county’s next sequential number. The permit
                  cannot be issued with a blank permit number.

                                            BURIAL WITHOUT PERMIT

If ultimate disposition has been made of the decedent before a burial-transit permit has been
issued, subsequent issuance will not remedy this violation of the vital statistics laws, nor
does its issuance serve any other useful purpose. These cases must be documented by the
local registrar and reported to the state registrar.

        DEATH THAT OCCURS IN ANOTHER REGISTRATION DISTRICT (COUNTY)

Local registrars are not to accept death certificates presented by funeral directors/direct
disposers that did not occur in their county, nor to accept permits for disposition. If the
registrar is in receipt of a death certificate for a death that occurred in another Florida
county, the appropriate county must be notified immediately of the error and the record sent
to that county.

                                  DISINTERMENT/REINTERMENT PERMIT

The Disinterment/reinterment Permit was repealed effective July 1, 1997. Should the CDR
receive an inquiry from a funeral director regarding disinterring human remains, they should
be reminded that the form no longer exists.

It is suggested that the funeral director type on funeral home letterhead stationery that the
form no longer exists and send the letter, accompanied by a certified copy of the death
certificate, along with the remains. The funeral director cannot complete another burial
transit permit for this purpose – remember, the BTP is for the “newly dead” and it’s only one
per customer.

All other statutory requirements for disinterring human remains are still in place. The repeal
of the disinterment/reinterment permit is the only thing that changed.

                    PHYSICIAN’S RESPONSIBILITY IN DEATH REGISTRATION

The primary responsibility of the physician in death registration is:
   1. To attest to the facts of death as they relate to date place and time of death;
   2. To complete the medical certification section of the death certificate, attesting to the
       cause of death to the best of their knowledge or belief*;
   3. The medical certification must be completed, signed and made available to the
       funeral director/direct disposer within 72 hours after receipt of the record;
   4. The physician is deemed responsible for knowledge of state statutes and the
       physician handbook regarding medical certification of causes of death.

*NOTE: Section 64V-1.0061 (3), Florida Administrative Code states, “ A death certificate is
prima facie proof of the fact, place, date, and time of death and identity of the decedent. A
physician’s signature and statement as to the cause of death does not constitute prima facie
proof of the cause of death.” The cause of death as determined by the certifying physician
does not have to be a scientific diagnosis. Statute allows that it be to the best knowledge


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and/or belief of the certifier. The only way an actual scientific diagnosis can be made is
through an autopsy. The physician cannot require that an autopsy be performed and
nowhere in statute does it require the family to have an autopsy done. If the case comes
under the medical examiner’s jurisdiction an autopsy may be part of their process, but this
can only be directed by the medical examiner.

When death occurs without medical attendance or when death is due to or with mention of
trauma, whether from accident, homicide or suicide, the physician should report the case to
the medical examiner.

When inquiry is required by the medical examiner, within 72 hours after taking charge of the
case:
   1. This official shall investigate the cause of death;
   2. Complete and sign the medical certification, or
   3. Complete a temporary record, indicating the cause of death is pending further
      investigation;
   4. Make application for the burial transit permit if there is no funeral home yet assigned
      to the case;

The medical certification shall be completed and signed by the physician in charge of the
decedent's care for the illness or condition that resulted in death, or by the physician in
attendance either at the time of death or immediately before or after. The certifier must
specify the hour of the day at which death occurred; and further state the cause(s) of death,
so as to show the course of events or sequence of causes resulting in the death, stating:
    1. First the condition causing death (terminal);
    2. Followed by any contributing (secondary) cause(s);
    3. Then the underlying cause or initiating disease condition with the corresponding
        durations.

Deaths that may be the result of either disease or violence must be carefully defined; and if
trauma is mentioned, items 46-52b, the means of injury, must be completed. Any
information that is not available to the certifier may be indicated as unknown or unavailable.
The Manner of Death, item 39, should be completed for all deaths, indicating whether it was
probably from natural causes, accident, suicide, homicide, or undetermined. If the manner
is stated to be other than "natural" or "undetermined,” a trauma must be reported in Part I or
Part II.

Subregistrars are responsible for reviewing the record and the medical certification to insure
that traumatic deaths are reported to the medical examiner's office.

                               WHO MAY SIGN MEDICAL CERTIFICATION

In cases where there is an attending physician, the following persons, when duly licensed
(pursuant to chapters 458, 459, and 460, F.S.) and registered in our state, are entitled to
complete and sign the medical certification of the death certificate: medical doctors,
osteopaths, and chiropractors. Where death occurs without medical attendance, the
medical certification on the death certificate must be signed by the medical examiner
(s. 382.011 (1), F. S.). Nurse practitioners (ARNP) and physicians’ assistants (PA) are not
authorized under statute to certify cause of death.




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                         PROBLEM GETTING PHYSICIAN TO SIGN RECORD

The physician in charge of the patient's care for the illness or condition that resulted in death
must complete the medical certification of the certificate of death within 72 hours after being
presented the death record by the funeral director. Many times the physician is reluctant to
sign a death record. He/she may feel they are not completely sure of the actual cause of
death or that it had been some time since they had last seen the decedent. The statute and
the death record, item 30, states the physician should determine cause of death to the best
of their ability. The funeral director must explain to the physician their responsibility and
reference s. 382.008 (3) F.S. regarding who the rightful certifier might be.

The following are some suggestions for the Chief Deputy Registrar when notified by a
funeral director that a physician is refusing to sign a death certificate:

     1. Funeral director’s responsibility (not funeral home staff):
        a. How did the funeral director (FD) determine who the certifier should be? Is there
           a possibility that another physician would sign?
        b. Did the FD confirm with the physician that he/she would sign the death certificate
           (DC)?
        c. What does the burial-transit permit (BTP) reflect for certifier?
        d. Why is the physician refusing to sign the DC according to the FD?
           1.) Not the physician’s patient?
           2.) Covering physician?
           3.) Hadn’t seen within 30 days?
           4.) Not expected to die?
        e. Where did the death occur? If at home, was there a police report? If so, the
           CDR should get a copy.
        f. Funeral director should provide written documentation to the CDR that shows all
           their efforts to have the physician certify the death (DRD can be used for this).
     2. Chief Deputy Registrar’s responsibility:
        a. CDR should speak directly with the funeral director, not the subregistrar or other
           office staff;
        b. Ensure the funeral director has spoken directly with the physician not the
           physician’s staff to discuss the physician’s unwillingness to certify the death;
        c. CDR should call the physician and find out unwillingness to sign DC;
        d. Remind the physician: the cause of death should be the physician’s best medical
           opinion. Terms such as “possible”, “probable”, etc. can be used when the
           certifier is not comfortable making an exact diagnosis. Death records can be
           amended at any time should additional information become available.
        e. Ask if there was any trauma or external event that they think might have caused
           the death and require the medical examiner to be contacted for investigation.
           Remind the physician that they need not be at the decedent’s bedside to certify
           death.
        f. Review ME responsibility under F.S., Chapter 406.
                1). Is it possible the death comes under their jurisdiction?
                2). Is the ME willing to contact the doctor and speak “physician to physician”?
        g. Remind the physician of their statutory obligation to sign a DC (found in Chapters
           382, 458 and 459, F.S.) and also that both the statute and the DC indicate “to the
           best of your knowledge...”;




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        h. If just “covering” for another physician, sign with “probable” COD. Attending
            physician can amend DC. The physician would treat patient if presented in office
            or hospital.
        i. Hadn’t seen in 30 days. Is it unreasonable to expect this patient to die? What
            had the physician been treating the patient for? Did the physician provide the
            decedent with renewable prescriptions that would have put them beyond the 30
            days?
        j. Fear of litigation. The DC is not going to be the instrument to incriminate the
            physician. Remind them of the rule, s. 64V-1.0061 (3), F.A.C.“ A death certificate
            is prima facie proof of the fact, place, date, and time of death and identity of the
            decedent. A physician’s signature and statement as to the cause of death does
            not constitute prima facie proof of the cause of death.”
        k. Did the death occur in a hospital or other facility? If so, contact the administrator
            or risk management office for assistance. Explain that this death was attended
            by at least one physician with admitting privileges to this hospital/facility and the
            appropriate physician should sign the death certificate.
        l. If the physician still refuses to sign DC, contact your Local Registrar (LR) for
            his/her involvement.
     3. Local Registrar’s responsibility -- CDR should provide all documentation to the LR
        along with a copy of the statute for their reference. The LR should contact the
        physician with the same questions as CDR, to determine reason for the refusal to
        sign. If LR is also a physician, this could help, again, physician to physician.
     4. Medical Examiner’s responsibility – ME jurisdiction is spelled out in s. 406.11 as
        well as in 382.11, F.S. If LR is unsuccessful in persuading the physician to certify
        the death, contact your district medical examiner (ME) for assistance. This does not
        mean, ask them to take jurisdiction of the case; simply ask for their assistance in
        getting the physician to understand their responsibility. The ME may have to explain
        his/her role under statute and how it differs from that of the attending physician.
        Most ME’s offices are glad to help.
     5. State Office’s responsibility -- If everyone is unsuccessful, contact your quality
        assurance field representative and provide copies of all documentation.

               RESPONSIBILITY IN DEATHS WITHOUT MEDICAL ATTENDANCE

In s. 382.011(1), F. S., a death occurring more than 30 days after the decedent was last
treated by a physician, except where death was medically expected as certified by an
attending physician, must be reported to the medical examiner. It is presumed if a physician
is treating a patient and prescribing medication(s) for a serious medical condition, this
physician is “attending”, even though the patient has not been seen by the physician in the
last 30 days. A physician covering for an absent colleague has access to the patient’s
medical records and can also be considered as attending. Pursuant to s. 406.11, F. S., the
medical examiner is responsible for the medical certification of cause of death in those
cases where the death is unattended by a physician.

Under that portion of the statute dealing with unattended deaths, the funeral director/direct
disposer or other person to whose knowledge the death may come, is required to notify the
medical examiner that a death occurring without medical attendance has come to his
attention. The funeral director/direct disposer may not dispose of the decedent prior to
registering the death certificate and/or obtaining a burial-transit permit.




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The local registrar will take whatever steps deemed necessary to ensure that a proper death
certificate is prepared and registered prior to authorizing a permit for disposition of the body.
If the medical examiner has not been notified, the registrar must refer the case to the district
medical examiner for investigation and certification.

              TEMPORARY (PENDING) DEATH RECORDS (S. 382.008(4, 5), F.S.)

When the medical certification of the cause of death cannot be completed within the allotted
time, due to a pending autopsy or medical examiner's report, a temporary (pending) death
record is to be registered with the local registrar. A temporary death record is to be
registered only in cases where the cause of death is unknown, pending autopsy or official
investigation, or where the decedent has not been identified. Temporary records are to be
forwarded to the state office in the usual manner. The CDR should keep a log or record of
all outstanding temporary records and follow-up with the funeral director after 30 days to
check on the status.

     A. Filing of temporary records:
        1. Must be registered before final disposition of the decedent, removal from state,
             and within five days after death or discovery of death;
        2. Must be completed with all information available at time of filing, except for the
             cause of death, and must be signed by the physician/medical examiner in charge
             of the case and the funeral director/direct disposer;
        3. The cause of death should be shown as "pending autopsy,” "pending
             investigation," etc. followed by an estimated date of replacement;
        4. A death certificate on an unknown decedent is considered a temporary record.
             The filing of a record must not be held up while waiting for identification of the
             remains. If the decedent is subsequently identified, the record can be replaced
             with a permanent record as outlined below.
     B. Filing of permanent replacement records:
        1. When the attending physician or medical examiner completes and determines
             the cause of death for a temporary death record already registered or the identity
             of the decedent, a new and complete record is to be registered as soon as
             practical as a permanent replacement for the temporary record;
        2. Any information that was unknown or incorrect on the temporary record may be
             completed and/or corrected on the permanent record;
        3. Changed or corrected information must be documented on the reverse side of
             the record and accompanied by either the funeral director's, physician's, or
             medical examiner's signature and date.
     C. Upon receipt of the permanent record, the local registrar must:
        1. Review the record carefully and compare it to the file copy of the temporary
             record previously filed, to ensure that all changes have been authorized;
        2. If there are changes that are not authorized, the record must be returned to the
             funeral director for proper authorization;
        3. Once accepted, the record must be labeled “Permanent Record” on the back and
             forwarded to the state office in such a manner as to be recognized as a
             permanent replacement for a temporary record (attach colored “permanent
             replacement” cover sheet);
        4. If the permanent record is transmitted with a batch of other death records:
                 a. It must not be counted as part of the shipment; it was already counted at
                      the time of filing the temporary record;



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                 b. CDR must make an entry on the appropriate line of the transmittal,
                    indicating the number of permanent replacement records included;
                 c. Attach a colored cover sheet to indicate the inclusion of a permanent
                    replacement record and place on top of the batch;
          5. The local file copy of the temporary record can be destroyed once the registrar is
             ensured the permanent record has been accepted for filing by the state office.
             Usually, maintaining the temporary local file copy for three months should ensure
             the permanent record was acceptable.

If the permanent replacement record is received before the local registrar has forwarded the
temporary record to the state office, it may be replaced at the local level. The temporary
record should be destroyed and only the permanent replacement record forwarded to the
state office. No notation on the record is required.

Temporary records can be amended prior to the filing of the permanent record. This is often
done when the family needs a certified copy right away and cannot wait for the permanent
record to be filed. Just be sure when the permanent record is filed that the information is in
agreement

                                              UNIDENTIFIED BODIES

A death certificate must be registered for unidentified human remains. The decedent’s
name must be listed as “Unknown.” This certificate must show all known or approximate
facts related to the body. The medical examiner should provide all information concerning
the place and circumstances under which the body was found. That portion of the record
relating to medical certification of the cause of death should be competed to the extent
possible.

A death certificate on an unknown decedent is considered a temporary record. If a body is
later identified to the satisfaction of the medical examiner and registrar, a new death
certificate must be prepared. This certificate will bear the same number as the original
certificate and should be processed as any permanent replacement of a temporary record.
It is possible that they will be identified before the final cause has been determined. It is
acceptable to file another temporary record with the identifying information and still have it
classified as temporary until the final cause has been determined.

              REVIEWING DEATH RECORD FOR TRAUMA IN CAUSE OF DEATH

When reviewing death certificates to determine acceptability for registering, an important
task of the subregistrar and/or chief deputy registrar is to examine the medical certification
section to determine if a case falls within the jurisdiction of the medical examiner and
should, therefore, be reviewed and signed by him/her. Cases where the medical examiner
would have a concern include deaths that involve: an act of criminal violence, an accident,
homicide, suicide, sudden death (includes sudden infant death syndrome or SIDS), criminal
abortion, poison, death while in an institution or police custody, and any other unusual
circumstances (s. 406.11 (1), F.S.). The medical examiner must be notified immediately if
such cases are detected, or if there is any doubt.

Generally, causes of death that should be certified by the local medical examiner are easily
recognized. However, there may be cases where unusual circumstances are not clearly



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indicated. In these cases, key words or phrases in the cause of death section must be
noted, such as:

abrasion
accident
bite
bruise
burns (thermal)
concussion
contusion
crushing
cut
drowning (near)
electric shock
exposure
exsanguination
fall
fracture
hanging
hematoma
hip nailing
hyperthermia
hypothermia
injury
laceration
MVA (motor vehicle
accident)
overdose
paraplegia
pulmonary emboli
puncture
quadriplegia
seizure disorder
strangulation
subarachnoid
hemorrhage
suffocation
trauma
wound




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These terms may suggest that a traumatic event occurred prior to death.

In the event that you receive a record with any of the causes listed above or which contains
one of these key words, and it has not been certified by the district medical examiner or item
40 has a "No" entry, you must contact the medical examiner immediately and inform him/her
of the case. The person who notifies the medical examiner should strike through the word
"No" in item 40, indicate "Yes,” and initial. Please note that we are not advising you to
contact the attending physician who certified the record nor question, in any way, the
physician's clinical diagnosis for cause of death.

Upon notification, the medical examiner may wish to contact the attending physician for
more information and may even decide to certify a new death certificate. This action should
be decided by the medical examiner. The chief deputy registrar must follow up on the case
to ensure that only one certificate is accepted for permanent filing.

In the event the medical examiner does not take jurisdiction in such cases and items 39
and/or 46-52b have not been completed, the certificate must be returned to the attending
physician for completion of these items. The funeral director must not complete these
items. If any of the information is not available to the certifier, an entry of "Unknown" or "Not
available" will be acceptable in the designated item.

You may wish to discuss these procedures with your district medical examiner in an effort to
see that all deaths that come within the jurisdiction of the medical examiner are properly
completed and certified by him/her as mandated by law.

                                 CORRECTION OF DEATH CERTIFICATES

Non-medical amendment: Correction or amendment of filed death records can only be
made by the state office. Demographic errors (those related to the personal information)
may be corrected by the Affidavit of Amendment to Death Record, DH 433. In addition to
the affidavit, documentary evidence is needed in support of major corrections. Changes to
marital status that affect the surviving spouse item require a court order. A $20.00 statutory
amendment fee is required and includes the issuance of one certification of the amended
record.

Medical amendments: Section 64V-1.007, F.A.C., states that the certifying physician or
medical examiner must make any change and/or correction to the Medical Certification of
the Cause of Death. This includes not only the cause of death and manner of death, but
also “…the date of death, hour or time of death or the place of death other than street
address…” The notarized Affidavit of Amendment to Medical Certification of Death,
DH 434A (for deaths in 2005 forward) or DH 434 (for deaths 2004 or older), is used for any
of these amendments. If there is an attending physician listed on the death certificate in
item 35, that physician, as well as the certifier listed in item 34b, has the authority to amend
the cause of death at any time, should it be necessary.

The medical affidavit is not the mechanism by which the medical examiner assumes
jurisdiction of a case recently filed with the state office. The CDR should contact the state
office registration unit and indicate the medical examiner has taken jurisdiction. If possible,
the record will be returned to the county and the medical examiner and funeral director can
start the process of preparing a new record.


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There is no amendment fee associated with a medical amendment; however, if a
certification of the amended death record is desired, a fee of $5.00 for the first copy and
$4.00 for each subsequent copy ordered at the same time is required. The Application for
Amendment to Florida Death Record, DH 524, is available for remittance of fees.

                                 LETTER OF NON-CONTAGIOUS DISEASE

There are times when a funeral director shipping a body out of the U.S. will ask for a letter or
statement indicating the death was from a non-contagious disease or condition that is not a
threat to public health. There is no mandated format for the letter.

In most cases, the chief health officer of the county where death occurs constructs this
letter/statement. She/he may ask for assistance from the chief deputy registrar, who may
construct the letter since the registrar is the one who will receive the death certificate for
filing. The health officer may review the death certificate to verify the cause of death or
she/he may contact the physician directly for verification.

In some areas, if the death was a medical examiner’s case, the medical examiner may
construct the letter/statement.

                                      DELAYED DEATH CERTIFICATES

A delayed death record is filed for a death that occurred beyond the current or prior year.
For deaths that occur beyond that timeframe, the CDR should contact the state office to
determine if it is possible to file the record locally. Normally, the funeral director or person
acting as such must file the record directly with the state office, furnishing a written
explanation for the delay in filing on the back of the record. In the case where a funeral
home failed to file a death record with the vital statistics office, the funeral home should
assist the family with necessary paperwork to support the filing of a delayed death record.
The attending physician or medical examiner with current jurisdiction must be available and
willing to certify as to the cause of death. An amendment fee of $20.00 is required and
includes the issuance of one certification of the death record.




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                                         INFANT DEATH/BIRTH MATCH

The death record should be reviewed for possible infant deaths:
   1. Check for deaths of infants less than 1 year of age.
   2. When it is noted that a deceased infant was also born in the same county as noted in
      item 7, Birthplace, the registrar must check their birth records to see if a birth
      certificate has been filed.
   3. If no birth record is on file, follow up with the funeral director or hospital to learn the
      circumstances of the birth and contact the appropriate party to get the record filed.
      a. Was it a Live Birth or Fetal Death?
      b. Could the hospital have determined it was a fetal death, but failed to inform the
           funeral home and the wrong form was filed?
      c. Could it have been a fetal death under 20 weeks gestation and therefore no
           record should be filed?
      d. Verify spelling of names of child and of parents
   4. If the death record is correct, put a note on the back of the record to indicate that a
      birth is on file, and if different, include the name under which the birth record is filed.

Periodic follow-up will be conducted from the state office on those situations where records
are not filed. A prompt response to such inquiries is appreciated. If the county is contacted
by the state office for follow-up on either a birth, death, or fetal death record
    1. CDR must contact the hospital or funeral home to determine the circumstances of
        the birth or death.
    2. CDR must keep contact until the correct record is filed and the case has been
        resolved

When working with infant deaths you will need to access the e-vault system.
  1. For the deaths that occur in your county, you must check to see if the birth also
      occurred in your county:
      a. If so, and you maintain local file copies of births, the CDR must mark the local file
          copy of the birth record of the deceased child;
      b. "DECEASED" must be printed in the upper left margin of the local file copy of the
          birth record so that it appears on any subsequent issuance for that local file copy.
      c. County indices, microfilm copies, and computer databases must also be flagged.
  2. If the death occurred in another county, but the residence indicates your county, you
      should determine if the county of birth is your county and mark your birth copy
      accordingly.
  3. If the residence is your county, but neither the birth nor death occurred in your
      county, you may be asked by the FIMR representative for a copy of the birth and/or
      death record. They can both be printed through the e-vault.

                                              PRESUMPTIVE DEATHS

A presumptive death is a determination by a court of competent jurisdiction that a death of a
resident of this state has occurred or is presumed to have occurred, but the body of the
person involved has not been located or recovered; or a death of a nonresident of this state
has occurred or is presumed to have occurred in this state, but the body of the person
involved has not been located or recovered.

Presumptive death records are filed directly with the state office. The local registrar is not to
accept for registering a death record based upon a presumptive death. The state office will


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accept for filing a presumptive death record when so ordered by a court of competent
jurisdiction and the judge issuing the order signs the medical certification (s. 382.012, F.S.).
Since there is no body, the services of a funeral director are not required.

Examples of situations when a presumptive record would be filed are a drowning accident in
which the remains were never recovered, a person leaves for the store and is never heard
from again, a plane crash in the ocean where no body is recovered, etc. Normally the family
or their legal representative initiates the filing of a presumptive death record. A packet of
information on filing procedures is available from the state office.

                      BURIAL OF HUMAN REMAINS AT SEA (EPA REGION 4)

According to federal regulations (40 CFR 229.1 (PDF) (1 p, 149K, About PDF) based on the
Marine Protection, Research and Sanctuary Act of 1972, human remains transported from
United States ports or on United States vessels or aircraft may be buried at sea under
specified conditions

These include cremated as well as non-cremated remains. Details on the specific
requirements, preparation of the body, disposal location and measures, forms to be filed
with the EPA, can be found at: http://www.epa.gov/region4/water/oceans/burial.htm

                         FAMILY MEMBER ACTING AS FUNERAL DIRECTOR

Section 382.002(7), Florida Statutes allows for someone to “act” as a funeral director in
effecting the final disposition of a decedent. This usually occurs when family members want
to act as their own funeral director. The family member must follow all the laws and rules
that pertain to funeral directors. Vital statistics is concerned with the proper and timely filing
of the burial-transit permit and death record.

The family member must contact the local vital statistics office within the county health
department, who will assist them in this process. Upon notification from a family member
that they intend to act as their own funeral director, the registrar will advise them of their
responsibilities as they pertain to vital statistics and obtain the following information:
    1. The decedent’s name, date of death and location of death;
    2. The family member’s name, address, phone number and relationship to the
        decedent;
    3. The physician’s name who will certify the death record;
    4. The location of death (hospital, hospice, nursing home, residence, etc.).

The registrar must then:
   1. Verify that the death occurred by contacting the physician who has agreed to certify
       the death certificate (it is suggested that the CDR contact the physician immediately
       to determine if they will sign the death record for the family member);
   2. If unfamiliar with the physician certifying the death, the license should be verified with
       the Department of Health; that web address is:
   3. www.doh.state.fl.us/IRM00PRAES/praslist.asp
   4. Obtain a copy of the police report or contact the physician, hospice, nursing home,
       etc., as appropriate;
   5. Report the death to the medical examiner if the death did not occur in a medical
       facility;



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The family member or representative must make an appointment with the chief deputy
registrar to obtain a blank death record and complete the application for burial-transit permit
(Part A). The permit cannot be issued at this time (Part B) unless the CDR has received
assurance from the physician that he/she will sign the death record. The CDR will provide
the applicant with instructions for completion of the death record (Chapter 5 in the
handbook. The CDR will advise the family member that final disposition cannot occur until a
completed death record is received in your office and you issue the burial-transit permit.

Upon receipt of the completed death certificate, the registrar must review the record for
completeness and accuracy. If acceptable, the CDR will issue the burial-transit permit
(complete Part B) and Instruct the applicant to return the original (white copy) permit within
10 days after final disposition to the vital statistics office in the county where disposition took
place.

Other items to be considered:
• A body must be buried within 24 hours of death unless embalmed or held in refrigeration
   at 40 degrees F (s. 497.386(2), F.S.)
• Transportation of a dead body must be done in a container that does not allow seepage
   of fluids or offensive odors (s. 497.386(3), F.S.)
• Cremation cannot take place until 48 hours after death (s. 872.03, F. S.)
• The physician must be willing to work with the family rather than a licensed funeral
   director.
• Obtaining paperwork and getting the registration process started might work with relative
   ease if a person dies at a “convenient” time, such as 8:00 am on a Tuesday. If death
   occurs at 2:45 am on a Saturday, it becomes more difficult to contact all the required
   parties.




NOTE: CDR should refer to the Vital Records Registration Handbook, Chapter 5, for
item-by-item instructions for the death record.




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                     CHAPTER 11 -- FETAL DEATH REGISTRATION

                                                          DEFINITION

Fetal death means death prior to the complete expulsion or extraction of a product of
human conception from its mother, if the 20th week of gestation has been reached and
the death is indicated by the fact that after such expulsion or extraction the fetus does
not breathe or show any other evidence of life such as beating of the heart, pulsation of
the umbilical cord, or definite movement of voluntary muscles (s. 382.002 (7), F.S.).

A delivery meeting this description must be recorded on the current certificate of fetal death
prescribed by the department. If the exact period of gestation is unknown, the physician
uses his/her best estimation, which may be based upon fetus weight in grams, length of
fetus, or other factors. Specifically, the period of gestation for fetal deaths includes only that
period or estimated period, during which the fetus is alive in utero and does not include the
time between death of the fetus and later expulsion or delivery.

NOTE: If the newborn, regardless of gestational age, breathes or shows other evidence of
life (per the physician) after complete expulsion or extraction, even though it is only
momentary, the delivery must be registered as a live birth, a birth certificate must be
prepared, and the subsequent preparation of a death certificate is required. If an infant dies
at birth, the hospital should make it clear to whoever assumes custody of the remains
whether a fetal death certificate (DH 428) or a death certificate (DH 512) should be filed.

Before accepting a fetal death for filing, the CDR should check the birth and death file to be
sure no other record has been filed on the fetus.

                          FETAL DEATH REGISTRATION (S. 382.008(1), F.S.)

Every fetal death of 20 or more weeks gestation shall be registered in the county in which
delivery occurred. Fetal death records are to be registered within five calendar days after
such delivery with the local registrar of the county where delivery occurred, and prior to final
disposition or removal of the fetus from the state. The burial transit permit must be obtained
within five days of delivery and filed with the county of death within 24 hours of issuance.
The permit can be faxed to the county vital statistics office. If the delivery occurs on a
moving conveyance, the record is to be registered in the county in which the fetus was first
removed from such conveyance.

If a funeral director/direct disposer handles the fetal death, essentially the same procedures
are followed as in cases of other deaths. The funeral director/direct disposer who first
assumes custody of the remains shall register the fetal death record. In the absence of
such person, the physician or other person in attendance at or after the delivery is
responsible for registering the record.

In case of twins or other multiple fetal deaths:
1. A separate record shall be prepared for each fetus.
2. The CDR must make sure all multiples are accounted for and that the pregnancy history
    is correct, cross referencing the Live Births and Fetal Deaths with notes on the back of
    each record.



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3. If a sibling dies prior to delivery and did not reach 20 weeks gestation, no record is filed
   and a note should be placed on the back of the filed sibling’s record

                                             SIGNATURES REQUIRED

The certificate of fetal death must be signed by the certifying physician within seventy-two
hours after being presented with the record. When inquiry is required by the medical
examiner or when fetal death occurs without medical attendance, the responsible official
shall sign the medical certification within 72 hours after taking charge of the case.

A midwife may not sign the fetal death record. If the delivery is attended by a midwife, her
license number, name, and title should be entered in items 29a-c. A Certified Nurse Midwife
(CNM), by statute, works under the direction of a physician. If the delivery is by a CNM, that
physician would sign in item 26 and certify the cause of death. The CNM’s license number,
name, and title should be entered in items 29a-c. A Licensed Midwife (LM) works
independently of a physician. If the delivery is by a LM and there has been no physician in
attendance in the past 30 days, the cause of death must be certified by the medical
examiner as an unattended death, pursuant to s. 382.011, F.S. The LM’s license number,
name, and title should be entered in items 29a-c.

If someone other than a physician or midwife attends the delivery, that person’s name
should be entered in item 29b. Other (Specify) should be checked in item 29c and father,
grandmother, paramedic, cab driver, etc. should be entered, depending on the status of the
attendant. The cause of death must be certified by the medical examiner as an unattended
death, pursuant to s. 382.011, F.S.

The funeral director/direct disposer will indicate the method of final disposition, sign the
record and file with the county vital statistics office. If applicable, the subregistrar will also
sign and date the record.

                         RESPONSIBILITY IN FETAL DEATH REGISTRATION

The physician's primary responsibility in the case of fetal death is to complete and sign the
cause of death section and enter the date of delivery. Other duties are: to determine if
delivery is a fetal death or live birth, to make the record available, within 72 hours of receipt,
to the funeral director/direct disposer in charge of the fetus so that it may be completed and
registered within the prescribed time, and to cooperate with the local and state registrars by
replying promptly to queries regarding any item on the certificate.

The hospital administrator is responsible for furnishing the required medical data,
items 36-55, within 72 hours of delivery to the funeral director in charge of the
arrangements.

Where a funeral director/direct disposer is involved, his responsibility in fetal death
registration is essentially the same as in death registration. The same is true of the
manager of cemeteries, crematoriums, or other premises where final disposition are made.
If the hospital makes final disposition, they must also comply with registration requirements.
They must obtain a burial transit permit from the CDR and obtain medical examiner approval
before final disposition, since that disposition is most likely to be incineration.




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                                        CHAPTER 11 – FETAL DEATH REGISTRATION




The Chief Deputy Registrar must make sure all multiples are accounted for and that the
pregnancy history is correct. Cross referencing notes should be placed on the back of the
sibling’s record(s), live birth or fetal death, especially if a sibling dies prior to delivery and
has not reached 20 weeks gestation, in which case, no record can be filed.

                                          DISPOSITION OF THE FETUS

After the proper record has been submitted for registration and a permit obtained, the fetus
may be disposed of in accordance with the wishes of the family. If the remains are taken
charge of by a funeral director/direct disposer, the required information, together with names
and addresses, must be shown on the certificate.

If the hospital makes final disposition, they must prepare and register the fetal death
certificate, obtain the permit, notify the medical examiner, and follow all laws and rules
regarding disposition as provided in chapter 470, F.S. If the remains are to be used in
medical study and/or cremated at a later date, the hospital must notify the medical examiner
as provided in chapter 406.11 (1) (c), F.S. Items 23a-b of the fetal death certificate must
show “Hospital Disposition,” the name of the hospital, and its location should be entered in
items 21 and 22a-b. The chief of staff, head of pathology department, or other appropriate
hospital official will act as “funeral director” and must sign the permit in item 6 and the fetal
death record in item 18b. Both the completed permit and fetal death record must be sent to
the local registrar within the statutory timeframe.

                                                  CONFIDENTIALITY

All information relating to cause of fetal death, parentage, marital status, and medical
information is confidential and exempt from s. 119.07(1), F.S.



NOTE: CDR should refer to the Vital Records Registration Handbook, Chapter 7, for
item-by-item instructions for the fetal death record.




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                                               CHAPTER 12 – DISASTER PLAN




                                  CHAPTER 12 – DISASTER PLAN

In the event of an emergency that affects the normal registration process of Florida vital
records, there must be a plan to handle various scenarios. The Office of Vital Statistics will
work cooperatively with the plans established by the department, as well as the Medical
Examiners’ Commission and the Florida Board of Funeral Directors. The office has
constructed an outline to be followed should such a situation occur.


BIRTH CERTIFICATE -- Hospital/Birthing Center

     1. Hospital is operational, but the county health department where they normally send
        the birth records is non-operational
        a. Prepare the birth certificates and Healthy Start forms as you normally would;
        b. Send the records and Healthy Start forms directly to the state office at the
             following address:
                  Office of Vital Statistics
                  Current Registration
                  P.O. Box 210
                  Jacksonville, FL 32231-0042
        c. Include a cover letter indicating who sent the records and a telephone number
             should there be any questions;
        d. If parents ask about obtaining certified copies, they can go to the nearest county
             office that is operational, for a birth certification, or they can contact the state
             office at 904/359-6900 ext. 9000. The vital statistics website is another option for
             obtaining certifications:
             http://www.doh.state.fl.us/planning_eval/vital_statistics/index.html
     2. Hospital forced to close for a period of time
        a. Secure any birth certificates that have been completed, but not yet mailed to the
             local office; once stable, mail to the county office, if operational, if not, mail to the
             state office at address shown above;
        b. When facility is operational, complete any outstanding birth certificates and follow
             above instructions. If parent is unavailable for signature, type mother’s name in
             item 22 and put a note on the back, in the upper right margin, indicating mother
             unavailable due to hurricane evacuation.
     3. If a birth occurs at a facility that does not normally deliver, hospital staff can contact
        the state office at 904/359-6900, either Paula Mundy at ext.1005 or Jim Ballard at
        ext. 1013.
        a. We will send some blank birth certificate forms and walk them through the
             process in getting the record completed and filed;
        b. There is a handbook on the website that goes item-by-item through the record
             and how to complete each item:
             http://www.doh.state.fl.us/planning_eval/vital_statistics/index.html
     4. State Office is Non-operational
        a. If county office is open, hospitals and birthing centers should file records locally,
             as they normally would;
        b. If county office is non-operational, facility should hold completed records in
             pending file until county office or state office is operational.



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                                               CHAPTER 12 – DISASTER PLAN




NOTE: If the hospital is without power the birth certificate and Healthy Start forms may be
legibly handwritten, preferably in black ink. Hospitals should keep a supply of the blank
forms for such emergencies.


DEATH CERTIFICATE – funeral director/medical examiner

     1. Funeral home is operational, but the county office where the death certificate
        should be filed is non-operational
        a. Registrars from other counties are to accept and review these records for
             acceptability, just as they would their own;
        b. Registrars will issue certifications accordingly;
        c. Burial Transit Permits should also be filed with the nearest operational county. If
             there is no subregistrar, the CDR can issue the permit.
        d. Due to power outages, records may be handwritten, preferably in black ink.
             Please print neatly and ensure all information is legible;
        e. The operational health department will forward all records to the state office;
        f. The state office will provide local file copies for those affected counties once they
             are up and running;
        g. During this period of recovery, concerns over noncompliance for timely filing
             during this period of emergency may be suspended;
        h. Should funeral directors receive questions regarding missing persons, presumed
             dead, they should refer those questions to Ken Jones, Deputy State Registrar at
             904/359-6982 or ken_jones@doh.state.fl.us for Presumptive Death filing
     2. Funeral home is non-operational, but has death certificates to be filed
        a. File the records with the nearest operational county office;
        b. If using a computer software package to generate the DC and have lost power,
             use the hard copy of the form;
        c. If funeral home does not have a supply of blank forms on hand, the funeral
             director should contact the nearest operational county office for forms;
        d. Due to power outages, records may be handwritten, preferably in black ink.
             Please print neatly and ensure all information is legible.
     3. If there is no funeral director available in the disaster affected area, the closest
        operational funeral home will step in to process the paperwork as well as handle the
        remains (per Board of Funeral and Cemetery Services Emergency Preparedness
        Committee Meeting, September 25, 2007).
     4. If death occurs in a hospital and the physician is unavailable, the funeral director
        should contact the hospital chief of staff to assist in providing the medical certification
        for a death occurring in the facility.
     5. If death occurs at home and the physician is unavailable, the medical examiner
        may be asked to assist in providing the medical certification.
     6. Medical Examiner has a body and the funeral home is non-operational, the ME
        should:
        a. Complete the death certificate with all available information (demographic as well
             as medical);
        b. Obtain the burial transit permit from the nearest operational county office;
        c. File the record with the nearest operational county office;
        d. If death occurs at home and the physician is unavailable, the ME may be asked
             to assist in providing the medical certification.




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                                               CHAPTER 12 – DISASTER PLAN




COUNTY VITAL STATISTICS OFFICE

If hospitals and funeral homes are affected by a natural disaster, such as a hurricane,
chances are the local vital statistics office will also be affected. County offices should
always maintain a supply of the hard copy birth, death, and fetal death forms for such
emergencies where no power is available and records must be completed by hand. Normal
compliance times will be relaxed in such situations. The following guidelines have been
established to assist the local vital statistics office in establishing a plan of action in such
occurrences.

     1. Birth Certificates – see hospital instructions.
        a. The state office will file the records received directly from the affected facility;
        b. Local file copies will be mailed to the county office once back in operation;
        c. Fatal errors encountered in the review process will be handled on a case-by-case
            basis.
     2. Death Certificates – see funeral director instructions.
        a. Construct a file for hurricane/disaster related events and keep for future
            reference (retention of 3 fiscal years)
            1). Make a list of decedents’ name, date of death, county of death, funeral home
                and date sent to state office;
            2). Note any discussions, or pertinent information to the file.
        b. CDRs may issue burial transit permits for deaths occurring outside of their
            county. Keep in file for forwarding to appropriate county at a later date.
        c. Review records as you would any other;
        d. Issue as requested;
        e. Send to state office under separate transmittal; indicate “Out-of County” on the
            transmittal form;
        f. State office will provide local file copies to affected CDRs for future issuance;
        g. Once affected CHD is back in business, CDR will no longer issue certifications
            from that office and local file copies should be destroyed.
     3. Securing of VS materials
        a. Safety Paper must be secured if left behind during an evacuation OR the paper
            can be taken to the new location
            1). Use of large, strong, plastic garbage bags helped during the last hurricane
                situation;
            2). Secure from unauthorized access whether relocated or left behind.
        b. Local file copies -- Secure books/files as you do the safety paper


WHAT IF STATE OFFICE IS AFFECTED? Should the county office be operational, but the
state office is temporarily non-operational due to a hurricane or other such disaster, the local
office will still continue to function as follows:

     1. Review, file, and issue certifications as usual;
     2. Hold all original records until word comes from state office as to how to proceed;
     3. If office has accepted records for out of county events, be sure to maintain in
        separate file.
     4. Construct file for any amendment questions received. Forward to state office once
        operational.




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                                               CHAPTER 12 – DISASTER PLAN




MASS FATALITY SITUATION - In the event of a mass fatality situation, such as a
pandemic related to flu, the state office will work cooperatively with the Florida medical
examiners (ME) in the filing of death records since these cases fall under their jurisdiction.
In past emergencies there have been executive orders from the governor directing agencies
to work expeditiously to reach their respective goals, and if necessary, to suspend some of
the “usual business practices”.

There are several things to be considered in a pandemic situation. Who have been
affected, is there a medical examiner/funeral director/county office available? As in a
natural disaster, this responsibility will fall to the closest operational, most logical choice. If
obtaining the necessary forms for death registration is an issue, again, what is the closest
most logical place to obtain them? In such an emergency, the website might be updated to
include a copy of the form to be used in this instance only.

•    ME generates the record (it will be the ME with current jurisdiction, or in the absence of
     that ME, one so designated, most likely the closest ME that is not affected by the
     disaster)
•    If there is a funeral director, the ME will release the remains to the funeral director
•    Funeral director will complete the demographic portion with the information available
•    Funeral director will file the record with the county vitals statistics office.
•    If the county of death’s vitals office is not operational, the record should be filed with the
     closest operational office.
•    County must submit record to the state office
•    If the state office is not operational, county staff must hold all original records until word
     comes from state office as to how to proceed
•    The county office staff should construct such files as necessary and as noted in disaster
     instructions outlined earlier in this document.

Questions regarding this plan should be directed to quality assurance at the state office.




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                                                          GLOSSARY


                                              GLOSSARY OF TERMS

The following definitions describe certain terms used in the manual:

Abandoned baby – a newborn infant abandoned at a fire station, emergency medical services
station or hospital within 7 days of birth, as referenced in s. 383.050, F.S..

Administrative regulations - Rules prescribed by the Department of Health for the administration
of vital statistics laws.

Applicant - person requesting a copy of a vital record.

Attendant at birth - Any person in attendance at the time of a live birth or delivery of a dead fetus.

Burial-transit permit - A permit required before disposition of a dead human body or fetus can be
legally completed.

Certificate of Birth Resulting in Stillbirth – a certification for fetal deaths which can be issued
upon the parent’s request. This issuance comes from the state office only and there must
already be a fetal death certificate on file. The certification will not be considered as proof of a
live birth, and once issued, is no longer a confidential record.

Certificate of Death - The original of the standard Certificate of Death as prescribed by the
Department of Health.

Certificate of Fetal Death - The original of the standard Certificate of Fetal Death as prescribed
by the Department of Health.

Certificate of Live Birth - The original standard Certificate of Live Birth as prescribed by the
Department of Health.

Certificate received - A certificate arriving in the registrar's office by mail or delivered in person,
but not yet accepted for registration or filing. In this manual, the term "record" is interchangeable
with the term "certificate."

Chief Deputy Registrar - A person appointed by the state registrar, upon recommendation of the
local registrar, to act in the absence or disability of the local registrar.

Computer certification - A document produced by computer or other electromagnetic equipment
containing all or part of the exact information contained on the original vital record, and which,
when certified by the state registrar, has the full force and effect of the original vital record.

Cremate - To reduce to ashes by the action of fire.

Dead body - A lifeless human body or parts of such body, by the state of which it may reasonably
be concluded that death has occurred.

Death without medical attendance - A death occurring more than 30 days after the decedent was
last treated by a physician, except where death was medically expected as certified by an
attending physician.


Chief Deputy Registrar Operations Manual, 2008 Revision                                            83
                                                          GLOSSARY


Direct disposer - Any person who is registered in this state to practice direct disposition and is
responsible for the preparation and registration of certificates of death and fetal death.

Designated representative - The person appointed by the hospital administrator to certify birth
records from the hospital.

Disposition of fetal remains - The burial, interment, cremation, release for scientific study, or
other final disposal of a dead fetus.

Electronic Birth Registration (EBRS) – the mechanism by which the hospital birth registrar
registers births through the Internet.

e-Vitals – The name of the electronic registration system for issuance, tracking, and accounting
for funds collected.

Filing of a record - Acceptance of a certificate by the local registrar. This term is synonymous
with registration.

Final disposition - The burial, cremation, or other disposition of a dead human body or fetus or
parts thereof.

Foundling – A “found” infant of unknown parentage.

Funeral director - A person licensed in this state to engage in the practice of preparing human
bodies for burial, and the directing and supervising of the burial or disposal of deceased human
bodies and responsible for the preparation and registration of certificates of death and fetal
death.

Gestational Surrogate - A woman who contracts to become pregnant by means of assisted
reproductive technology without the use of an egg from her body.

Informant - The person who supplies the data regarding the personal particulars required for the
preparation of a Certificate of Live Birth, Death, or Fetal Death. For birth, this must be a parent
of the child.

Live birth - The complete expulsion or extraction from its mother of a product of human
conception, irrespective of the duration of pregnancy, which, after such expulsion or extraction,
breathes or shows any other evidence of life such as beating of the heart, pulsation of the
umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has
been cut or the placenta is attached.

Local Registrar - The county health department director or administrator, who under the direction
of the state registrar of vital records, is in charge of the registration of births, deaths, and fetal
deaths within a specified local registration district. He has the further responsibility of carrying
out duties incidental to enforcement of vital statistics laws within his registration district.

Local registration district - A specific geographic area designated by the state registrar of vital
records as a part of the statewide vital records registration system. In our state, registration
districts conform to the jurisdictional boundaries of the county health departments.




Chief Deputy Registrar Operations Manual, 2008 Revision                                             84
                                                          GLOSSARY


Medical Examiner - A physician appointed by medical examiner district (not necessarily
contiguous with local registration districts) whose duty it is to investigate the circumstances and
determine the cause of death when the death is suspected or appears to have occurred by
criminal violence, by accident, homicide, suicide, death without medical attendance, in prison, or
under any suspicious or unusual circumstance. A further duty is the preparation of the medical
section of the death or fetal death record in those cases handled by him. The medical examiner
is a physician with special training in forensic pathology.

Midwife - A person licensed to attend women at or during childbirth (other than a physician) and
who accepts compensation for these services.

Moving conveyance - Any means of transportation, public or private, such as bus, train, plane, or
automobile.

Office of Vital Records and Public Health Statistics - The office responsible under the state
registrar for the administration of vital statistics laws and regulations and the collection and
preservation of the vital records of Florida. In this manual, the term is synonymous with "the state
office."

Person in charge of interment - Any person who places, or causes to be placed, a dead body or
a dead fetus in a grave, vault, urn, or other receptacle or otherwise disposes of such remains.

Physician - A person authorized to practice medicine, osteopathic medicine, or chiropractic
medicine pursuant to chapter 458, chapter 459, or chapter 460, Florida Statutes.

Presumptive death - Determination by a court of competent jurisdiction that a death has occurred
or is presumed to have occurred in this state, but the body of the person involved has not been
located or recovered.

Putative Father - a man who believes he may have fathered a child and wishes to preserve his
rights to be noticed should the child be placed for adoption.

Putative Father Registry - the registry is where the putative father claim is filed and recorded.

Registrant - The child entered on a birth certificate, the deceased entered on a death certificate,
and both the husband and wife entered on a marriage or dissolution of marriage record.

Registration - The acceptance for filing of a Certificate of Live Birth, Death, or Fetal Death by the
local registrar.

Sexton - A person having charge of a cemetery or burial ground, either public or private.

State file number - A number assigned to a vital record by the Office of Vital Statistics for legal,
index, and identification purposes.

State Registrar - The person specified by state law to direct the operations of the state office of
vital records and public health statistics and to oversee vital records registration in the districts.
He furnishes all necessary forms to local registrars and investigates violations of vital statistics
laws.




Chief Deputy Registrar Operations Manual, 2008 Revision                                            85
                                                          GLOSSARY


Subregistrar - A person appointed by the state registrar to receive death and fetal death
certificates and to issue Burial-Transit Permits.

Surrogate - A woman who contracts to become pregnant by means of assisted reproductive
technology with the use of her own egg.

Vital records - Official and original certificates of birth, death, and fetal death. Also includes
records of marriage and dissolution of marriage.

Vital statistics laws - The Vital Statistics Act is legislation enacted to provide a system for
collection and preservation of vital records. The vital statistics act is located in Chapter
382, Florida Statutes.

Vital statistics and records system - The registration, collection, preservation, amendment,
and certification of vital records, and activities related thereto, including the tabulation,
analysis, and publication of statistical data derived from such records.




Chief Deputy Registrar Operations Manual, 2008 Revision                                              86
                                                          ATTACHMENT A

                                                               FORMS


For a complete listing of forms and brochures, check the forms catalog on the DOH warehouse web
site at: http://dohiws/Divisions/Administration/FormsAdmin/Forms/DCcatalog.xls

The state office, Administrative Services Unit sends a monthly listing of forms availability. The following
forms should be available in every county vital statistics office:

     1.  Birth record – DH 511;
     2.  Death record – DH 512;
     3.  Fetal Death record – DH 428;
     4.  Burial-transit permit – DH 326;
     5.  Transmittals – DH 758A, B and C (on VS Intranet website; may be photocopied);
     6.  Affidavits to Amend (on VS Intranet website; may be photocopied);
         a. Birth record – DH 430;
         b. Death record – DH 433;
         c. Death record, cause of death (medical) – DH 434 (for 2004 deaths and older);
         d. Death record, cause of death (medical) – DH 434A (for 2005 deaths forward only);
         e. Fetal Death Record, cause of Death (medical) – DH 434B (available February 2006)
     7. Acknowledgment of Paternity – DH 432 (on VS Intranet website; may be photocopied);
     8. What You as a Parent must know before Signing the Paternity Acknowledgement by Natural
         Parents, DH 1568; hospitals are required to provide this to both parents when acknowledging
         paternity (on VS Internet website; may be photocopied)
     9. Death Registration Delay (DRD) – DH 1355 (on VS Internet website; may be photocopied);
     10. State office applications (on VS Internet website; may be photocopied);
         a. Birth record – DH 726;
         b. Death record – DH 727;
         c. Marriage record – DH 261;
         d. Dissolution of Marriage record – DH 260;
         e. Birth amendment – DH 429;
         f. Death amendment – DH 524;
     11. Brochures - available from warehouse and also on website;
         a. What You Need to Know Before Signing Your Baby’s Birth Certificate, DH 150-356;
         b. What the Physician Should Know about Certifying Cause of Death on the Florida Death
             Certificate, DH 150-849;
         c. How to Apply for a Florida Certificate of Birth Resulting in Stillbirth, DH 150-933
         d. What’s Needed for a Vital Record for a Foreign Country? Apostille/Exemplified is the
             Answer!, DH 150-935
         e. Identity Theft, DH 150-938
         f. Putative Father Registry, DH 771 (English), DH 772 (Spanish), DH 773 (Creole)
     12. Sample noncompliance letters (attachment in this manual);
     13. Commission applications for (attachments in this manual):
         a. Chief Deputy Registrar;
         b. Deputy Registrar;
         c. Local Registrar;
         d. Subregistrar
     14. Putative Father forms (on VS Internet website; may be photocopied);
         a. Application for Search, DH 1963
         b. Claim of Paternity, Update to Registration, DH 1964
         c. Claim of Paternity, DH 1965
         d. Putative Father Registry brochure-- DH 771 (English), DH 772 (Spanish), DH 773 (Creole)

Chief Deputy Registrar Operations Manual, 2008 Revision                                          87
                                                         ATTACHMENT C


                                                         WEB SITES

Department of Health:
http://www.doh.state.fl.us/

Florida Statutes:
www.leg.state.fl.us
Chapter 382 – Vital Statistics
Chapter 119 – Public Records
Chapter 381 – Public Health
Chapter 406 – Medical Examiner
Chapter 458 – Physicians
Chapter 459 – Osteopaths
Chapter 460 – Chiropractic
Chapter 467 - Midwifery
Chapter 497 – Funeral, Cemetery, and Consumer Services
Chapter 742 -- Surrogacy
Chapter 872 – Offenses Concerning Dead Bodies and Graves (cremation authorization)

Chapter 64V-1 – Vital Statistics Florida Administrative Code/Rule:
http://fac.dos.state.fl.us

National Center for Health Statistics – “Where To Write For Vital Records:”
http://www.cdc.gov/nchs/w2w.htm

Verify Florida license of funeral director, direct disposer or funeral establishment:
http://www.fldfs.com/FuneralCemetery/fc_license_search.htm

Verify Florida license of physician or licensed midwife:
http://ww2.doh.state.fl.us/IRM00PRAES/PRASLIST.ASP

Verify Florida license of an attorney:
http://www.floridabar.org/names.nsf/MESearch?OpenForm

Check addresses for proper city and county:
http://www.usps.com/




Chief Deputy Registrar Operations Manual, 2008Revision                                  89
                                                               ATTACHMENT C

     FOREIGN OR HIGH-SEAS BIRTHS AND DEATHS AND CERTIFICATES OF CITIZENSHIP
Birth records of persons born in foreign countries                           6.   the signature of the requestor and the requestor's
who are U.S. citizens at birth                                                    relationship to the subject;
           The birth of a child abroad to U.S. citizen parent(s)             7. a check or money order for $30.00 for the FS-240,
should be reported to the nearest U.S. Consulate or Embassy as                    $30.00 for the first DS-1350 and $20.00 for each
soon after the birth as possible. To do this, the child's parent or               additional issued at the same time per document
legal guardian should file an Application for Consular Report of                  requested, made payable to the U.S. Department of
Birth Abroad of a Citizen of the United States of America (Form                   State; and
FS-579/SS-5). This form may also be used to apply for a Social               8. if applying for a replacement FS-240, a notarized
Security Number for the child. A $40.00 fee is charged for                        affidavit by the subject, parent, or legal representative
reporting the birth.                                                              that states the name, date and place of birth of the
      The application must be supported by evidence to establish                  subject, and the whereabouts of the original FS-240.
the child's U.S. citizenship. Usually, the following documents are           To obtain a Consular Report of Birth in a new name, send a
needed:                                                                 written request and fees as noted above, the original (or
      1. the child's birth certificate;                                 replacement) Consular Report of Birth, or if not available, a
      2. evidence of the U.S. citizenship of the parent(s) such as      notarized affidavit about its whereabouts. Also, send a certified
           a certified copy of a birth certificate, U.S. passport, or   copy of the court order or final adoption decree which identifies
           Certificate of Naturalization or Citizenship;                the child and shows the change of name with the request. If the
      3. evidence of the parents' marriage, if applicable; and          name has been changed informally, submit public records and
      4. affidavit(s) of the physical presence of the parent(s) in      affidavits that show the change of name.
           the United States.
      Each document should be certified as a true copy of the           Birth records of alien children adopted by U.S.
original by the registrar of the office that issued the document.       citizens
Other documents may be needed in some cases. Contact the                           Birth certifications for alien children adopted by U.S.
nearest U.S. Embassy or Consulate for details on what evidence is       citizens and lawfully admitted to the United States may be
needed.                                                                 obtained from the Immigration and Naturalization Service (INS)
      When the application is approved, a Consular Report of Birth      if the birth information is on file. (Address can be found in a
Abroad of a Citizen of the United States of America (Form FS-           telephone directory.) To obtain the birth data, it is necessary to
240) is given to the applicant. This document, known as the             provide the Immigration Office with proof of adoption or
Consular Report of Birth, has the same value as proof of                legitimation.
citizenship as the Certificate of Citizenship issued by the
Immigration and Naturalization Service.
                                                                        Certificate of citizenship
A Consular Report of Birth can be prepared only at a U.S.
                                                                                   Persons who were born abroad and later naturalized as
Embassy or Consulate overseas, and only if the person who is the
                                                                        U.S. citizens or who were born in a foreign country to a U.S.
subject of the report is under 18 years of age when the application
                                                                        citizen (parent or parents) may apply for a certificate of
is made. A person residing abroad who is now 18 years of age or
                                                                        citizenship pursuant to the provisions of Section 341 of the
over, and whose claim to U.S. citizenship has never been
                                                                        Immigration and Nationality Act. Application can be made for
documented, should contact the nearest U.S. Embassy or
                                                                        this document in the United States at the nearest office of the
Consulate for assistance in registering as a U.S. citizen.
                                                                        Immigration and Naturalization Service (INS). The INS will issue
           As of November 1, 1990, the U.S. Department of State
                                                                        a certification of citizenship for the person if proof of citizenship
no longer issues multiple copies of the Consular Report of Birth.
                                                                        is submitted and the person is within the United States. The
However, a replacement Consular Report of Birth may be issued
                                                                        decision whether to apply for a certificate of citizenship is
if the original document is lost or mutilated. The U.S. Department
                                                                        optional; its possession is not mandatory because a valid U.S.
of State also issues certified copies of the Certification of Report
                                                                        passport or a Form FS-240 has the same evidentiary status.
of Birth (DS-1365), which contains the same information as on
the Consular Report of Birth. The DS-1365 serves most needs and
can be issued in multiple copies. Documents are issued only to          Death records of U.S. citizens who die in foreign
the subject of the Consular Report of Birth, the subject's parents      countries
or legal guardian, or a person who submits written authorization                   The death of a U.S. citizen in a foreign country may be
from the subject.                                                       reported to the nearest U.S. consular office. If reported, and a
      To request copies of the DS-1365 or a replacement FS-240,         copy of the local death certificate and evidence of U.S.
write to Passport Services, Correspondence Branch, U.S.                 citizenship are presented, the consul prepares the official Report
Department of State, 1111 19th Street NW, Suite 510,                    of the Death of an American Citizen Abroad' (Form OF-180). A
Washington, DC 20522-1705. Please include the following items:          copy of the Report of Death is then filed permanently in the U.S.
      1. the full name of the child at birth (and any adoptive          Department of State (see exceptions below).
           name);                                                                  To obtain a copy of a report filed in 1975 or after, write
      2. the date and place of birth;                                   to Passport Services, Vital Records Section, U.S. Department of
      3. the names of the parents;                                      State, Washington, DC 20522-1705. The fee for a copy is $30.00
      4. the serial number of the FS-240 (if the FS-240 was             for the first copy, $20.00 for each additional copy. Fee may be
           issued after November 1, 1990);                              subject to change.
      5. any available passport information;                                       Reports of Death filed before 1963 are maintained by
                                                                        the National Archives and Records Service, Diplomatic Records
Chief Deputy Registrar Operations Manual, 2008Revision                                                                                     91
                                                                 ATTACHMENT C
Branch, Washington, DC 20408. Requests for such records                         To request copies, write to Correspondence Branch, Passport
should be sent directly to that office.                                    Services, U.S. Department of State, 1111 19th Street NW, Suite
          Reports of deaths of persons serving in the Armed                510, Washington, DC 20522-1705. Please include the following
Forces of the United States (Army, Navy, Marines, Air Force, or            items for birth , death, or marriage:
Coast Guard) or civilian employees of the Department of Defense                 1. the full name of subject at the time of event;
are not maintained by the U.S. Department of State. In these                    2. month, day and year of event;
cases, requests for copies of records should be sent to the                     3. place of event (city and country);
National Personnel Records Center (Military Personnel Records),                 4. parents' names, date and place of birth, and nationality
9700 Page Ave., St. Louis, Missouri 63132-5100.                                      for birth record;
                                                                                5. any available U.S. passport information;
Records of birth and death occurring on vessels or                              6. signature of the requestor, parent or guardian, or legal
                                                                                     representative;
aircraft on the high seas
                                                                                7. requestor address and telephone number;
     When a birth or death occurs on the high seas, whether in an
aircraft or on a vessel, the record is usually filed at the next port          8.   a check or money order for $30.00 and $20.00 for each
of call.                                                                            additional copy issued at the same time, made payable
     1. If the vessel or aircraft docked or landed at a foreign                     to U.S. Department of State. Do not send cash.
          port, requests for copies of the record may be made to
          the U.S. Department of State, Washington, DC 20522-
          1705.
     2. If the first port of entry was in the United States, write
          to the registration authority in the city where the vessel
          or aircraft docked or landed in the United States.
     3. If the vessel was of U.S. registry, contact the local
          authorities at the port of entry and/or search the vessel
          logs at the U.S. Coast Guard Facility at the vessel's final
          port of call for that voyage.

Records maintained by foreign countries
          Most, but not all, foreign countries record births and
deaths. It is not possible to list in this publication all foreign vital
records offices, the charges they make for copies of records, or
the information they may require to locate a record. However,
most foreign countries will provide certifications of births and
deaths occurring within their boundaries.
          Persons who need a copy of a foreign birth or death
record should contact the Embassy or the nearest Consulate in the
U.S. of the country in which the death occurred. Addresses and
telephone numbers for these offices are listed in the U.S.
Department of State Publication 7846, Foreign Consular Offices
in the United States, which is available in many local libraries.
Copies of this publication may also be purchased from the U.S.
Government Printing Office, Washington, DC 20402.
          If the Embassy or Consulate is unable to provide
assistance, U.S. citizens may obtain assistance by writing to the
Office of Overseas Citizens Services, U.S. Department of State,
Washington, DC 20520-4818. Aliens residing in the United States
may be able to obtain assistance through the Embassy or
Consulate of their country of nationality.


Records of birth, death, and marriage in the Panama
Canal Zone for U.S. citizens and foreign nationals
           From 1904 until 1979, the Canal Zone Government
registered all civil acts of birth, death, and marriage in the Canal
Zone for U.S. citizens and foreign nationals. Since 1979, the
Panama Canal Commission has issued certified copies of these
documents in response to requests from the public. On December
31, 1999, the Panama Canal Commission will no longer exist. On
December 1, 1999, those records were transferred to Passport
Services in the U.S. Department of State, which will provide the
certification service just as it does for similar records issued by
U.S. Embassies and Consulates abroad.

Chief Deputy Registrar Operations Manual, 2008Revision                                                                   92
                                      ATTACHMENT D


           SAMPLE NONCOMPLIANCE LETTER TO HOSPITAL FOR LATE
                         BIRTH CERTIFICATES

CERTIFIED MAIL

Name (Medical Records Director or whoever has authority for birth registration)
Facility Name
Address
City, State, Zip

                                                       RE: Child’s name
                                                           DOB

Dear Mr./Ms. _______________:

A birth certificate on the above referenced child has not been submitted to this vital
statistics office. Pursuant to s. 382.013, Florida Statutes, a birth certificate must be filed
within five (5) calendar days after birth. It is the responsibility of the hospital
administrator to have the birth certificate filed in a timely manner.

(#1) Please ensure that all birth certificates are filed on time in the future. If you have
any questions, please refer to your Vital Records Registration Handbook, which contains
specific instructions on the proper and timely filing of birth certificates. If there were
mitigating circumstances in the above referenced case, or if you have any questions
regarding your responsibility in the birth registration process, please call me at (phone
#).

(#2) This is your second notice of noncompliance regarding the timely filing of birth
certificates. If you do not fully understand your responsibilities in birth registration,
please contact me for additional training.

(#3) Noncompliance with s. 382.013, F.S. may result in the filing of Administrative
Complaint against you pursuant to s. 382.026, F.S. Notification of this violation is being
forwarded to the Quality Assurance Unit, Office of Vital Statistics for their review and
investigation.[This third notice should be sent Certified Mail-Return Receipt Requested.]


                                       Sincerely,



                                       Chief Deputy Registrar

cc:    Local Registrar
       Hospital Administrator
       (#3) Quality Assurance Field Representative, Office of Vital Statistics
       [Attach copies of previous non-compliance letters and copies of the BCs, if filed.]




                                                                                             93
                                       ATTACHMENT D


        SAMPLE NONCOMPLIANCE LETTER TO MIDWIFE FOR LATE BIRTH
                           CERTIFICATES

CERTIFIED MAIL

Name (Licensed or Certified Nurse Midwife)
Facility Name (if applicable)
Address
City, State, Zip

                                                        RE: Child’s name
                                                            DOB

Dear Mr./Ms. _______________:

A birth certificate on the above referenced child has not been submitted to this vital
statistics office. Pursuant to s. 382.013, Florida Statutes, a birth certificate must be filed
within five (5) calendar days after birth. It is the responsibility of the attendant at birth to
have the birth certificate filed in a timely manner.

(#1) Please ensure that all birth certificates are filed on time in the future. If you have
any questions, please refer to your Vital Records Registration Handbook, which contains
specific instructions on the proper and timely filing of birth certificates. If there were
mitigating circumstances in the above referenced case, or if you have any questions
regarding your responsibility in the birth registration process, please call me at (phone
#).

(#2) This is your second notice of noncompliance regarding the timely filing of birth
certificates. If you do not fully understand your responsibilities in birth registration,
please contact me for additional training.

(#3) Noncompliance with s. 382.013, F.S. may result in the filing of Administrative
Complaint against you pursuant to s. 382.026, F.S. Notification of this violation is being
forwarded to the Quality Assurance Unit, Office of Vital Statistics for their review and
investigation.[This third notice should be sent Certified Mail-Return Receipt Requested.]


                                        Sincerely,



                                        Chief Deputy Registrar

cc:     Local Registrar
        Chief Deputy Registrar (if county other than your own)
        (#3) Quality Assurance Field Representative, Office of Vital Statistics
        [Attach copies of previous non-compliance letters and copies of the BCS, if filed.]




                                                                                               94
                                      ATTACHMENT D


      SAMPLE NONCOMPLIANCE LETTER FOR LATE DEATH CERTIFICATE

CERTIFIED MAIL                                                    NOTE: if both the death record
                                                                  and the burial transit permit are
                                                                  late, it is not necessary to
Funeral Director                                                  construct two different letters.
Establishment Name                                                Include all information in the
Address                                                           same letter.
City, State, Zip

                                                      RE: Decedent’s name
                                                          DOD

Dear Mr./Ms. _____________: [address by name, do not use “Dear Funeral Director”]

A death certificate on the above name decedent has not been filed in this office. The
death certificate must be filed within five (5) calendar days after death and prior to final
disposition (s. 382.008, Florida Statutes) unless an extension of time has been granted.
The record was due on ________, making the record ____ days late (Include the date
the record was due and calculate the number of days the record is late). [Option A - In
this case an extension of time for filing the death certificate was not granted on the
burial-transit permit. Option B - In this case an extension of time for filing the death
certificate was granted, however the registration date has passed.]

(#1) Please ensure that death certificates are filed on time in the future. If you have any
questions, refer to your Vital Records Registration Handbook, which contains specific
instructions on the proper and timely filing of death certificates. If there were mitigating
circumstances in the above referenced case, or you have any questions regarding your
responsibility in death registration process, please contact me (CDR) at (phone #).
OR
(#2) This is your second notice of noncompliance regarding the timely filing of death
certificates. If you do not fully understand your responsibilities in death registration,
please contact me for additional training.
OR
(#3) Noncompliance with s. 382.008, F.S. may result in the removal of your
subregistrar’s commission and/ or the filing of an Administrative Complaint against you
pursuant to s. 382.026, F.S. Notification of this violation is being forwarded to the
Quality Assurance Unit, Office of Vital Statistics for their review and investigation.
[This 3rd notice should be sent Certified Mail-Return Receipt Requested.]

                                      Sincerely,


                                      Chief Deputy Registrar
cc:    Subregistrar
       Local Registrar
       CDR (if county other than your own)
       Funeral Director in charge (if different than addressee)
       (#3) Quality Assurance Field Representative, Office of Vital Statistics
       [Attach copies of previous non-compliance letters and copies of the BTPs and
       DCs, if filed.]



                                                                                               95
                                     ATTACHMENT D


      SAMPLE NONCOMPLIANCE LETTER FOR LATE BURIAL-TRANSIT PERMIT

CERTIFIED MAIL
                                                                    NOTE: if both the death record
                                                                    and the burial transit permit are
Funeral Director
                                                                    late, it is not necessary to
Establishment Name                                                  construct two different letters.
Address                                                             Include all information in the
City, State, Zip                                                    same letter.

                                                     RE: Decedent’s name
                                                         DOD

Dear Mr./Ms. _____________:[address by name, do not use “Dear Funeral Director”]

A burial-transit permit on the above name decedent has not been filed in this office. The
burial-transit permit must be filed within five (5) calendar days after death and prior to
final disposition (s. 382.006, Florida Statutes). The permit was due on ________,
making it ____ days late (Include the date the permit was due and calculate the number
of days late).

(#1) Please ensure that burial-transit permits are filed on time in the future. If you have
any questions, refer to your Vital Records Registration Handbook, which contains
specific instructions on the proper and timely filing of burial-transit permits and death
certificates. If there were mitigating circumstances in the above referenced case, or you
have any questions regarding your responsibility in death registration process, please
contact me (CDR) at (phone #).
OR
(#2) This is your second notice of noncompliance regarding the timely filing of burial-
transit permits. If you do not fully understand your responsibilities in death registration,
please contact me for additional training.
OR
(#3) Noncompliance with s. 382.006, F.S. may result in the removal of your
subregistrar’s commission and/ or the filing of an Administrative Complaint against you
pursuant to s. 382.026, F.S. Notification of this violation is being forwarded to the
Quality Assurance Unit, Office of Vital Statistics for their review and investigation.
[This 3rd notice should be sent Certified Mail-Return Receipt Requested.]

                                      Sincerely,



                                      Chief Deputy Registrar

cc:     Subregistrar
        Local Registrar
        CDR (if county other than your own)
        Funeral Director in Charge (if other than addressee)
        (#3) Quality Assurance Field Representative, Office of Vital Statistics




                                                                                              96
                                      ATTACHMENT D


  SAMPLE NONCOMPLIANCE LETTER FOR LATE FETAL DEATH CERTIFICATE

CERTIFIED MAIL

Funeral Director
Establishment Name
Address
City, State, Zip

                                                       RE: Decedent’s name
                                                           DOD

Dear Mr./Ms. ______________:[ address by name, do not use “Dear Funeral Director”]

A fetal death certificate on the above name decedent has not been filed in this office.
The death certificate must be filed within five (5) calendar days after death and prior to
final disposition (s. 382.008, Florida Statutes) unless an extension of time has been
granted. The record was due on ________, making the record ____ days late (Include
the date the record was due and calculate the number of days the record is late). [Option
A - In this case an extension of time for filing the fetal death certificate was not granted
on the burial-transit permit. Option B - In this case an extension of time for filing the fetal
death certificate was granted, however the registration date has passed.]

(#1) Please ensure that fetal death certificates are filed on time in the future. If you
have any questions, refer to your Vital Records Registration Handbook, which contains
specific instructions on the proper and timely filing of fetal death certificates. If there
were mitigating circumstances in the above referenced case, or you have any questions
regarding your responsibility in fetal death registration process, please contact me
(CDR) at (phone #).
OR
(#2) This is your second notice of noncompliance regarding the timely filing of fetal
death certificates. If you do not fully understand your responsibilities in fetal death
registration, please contact me for additional training.
OR
(#3) Noncompliance with s. 382.008, F.S. may result in the removal of your
subregistrar’s commission and/ or the filing of an Administrative Complaint against you
pursuant to s. 382.026, F.S. Notification of this violation is being forwarded to the
Quality Assurance Unit, Office of Vital Statistics for their review and investigation.
[This 3rd notice should be sent Certified Mail-Return Receipt Requested.]

                                       Sincerely,

                                      Chief Deputy Registrar
cc:    Subregistrar
       Local Registrar
       CDR (if county other than your own)
       Funeral Director in Charge (if other than addressee)
       (#3) Quality Assurance Field Representative, Office of Vital Statistics
       [Attach copies of previous non-compliance letters and copies of the BTPs and
       DCs, if filed.]



                                                                                             97
                                        ATTACHMENT D


                 SAMPLE NONCOMPLIANCE LETTER TO PHYSICIAN

CERTIFIED MAIL

M.D. or D.O.’s name
address
City, State, Zip

                                                         RE: Decedent’s name
                                                             DOD

Dear Dr. __________:

In order for death registration to proceed efficiently as required by Florida Statute, it is
necessary that all who are party to the process fulfill their responsibilities promptly.
While statute places the responsibility for initiating and filing the death certificate with the
funeral director/direct disposer, it is the responsibility of the physician to provide the
medical certification as to cause-of-death within seventy-two (72) hours after receipt of a
death or fetal death certificate (s. 382.008(3), F.S.). If a physician fails to fulfill his or her
obligation, a delay in registering the death certificate results, which frequently causes a
marked hardship on the family of the decedent.

Noncompliance with s. 382.008(3) can result in an administrative complaint being
initiated against you. This would place you in noncompliance with sections 455.225 and
458.331, F.S. (or s. 459.011, F.S. for D.O.s) and Florida Administrative Code 59R-
8.011. The ultimate goal of this office is to have all death and fetal death certificates
filed in a timely manner.

In the case referenced above, the following is a brief description of the problem the
funeral director/direct disposer encountered with the death certificate.

(Describe problem from the information received on the Funeral Director/Direct Disposer
Report and/or the Burial-Transit Permit.)

Your future cooperation in the prompt completion and signing of death certificates will be
appreciated, not only by this office but by the families of the decedents.

                                         Sincerely,



                                         Local Registrar/Chief Deputy Registrar

cc:     Local Registrar/Chief Deputy Registrar
        Funeral Director/Direct Disposer
        Quality Assurance Field Representative, Office of Vital Statistics




                                                                                                98
                                            ATTACHMENT F


                              FACSIMILE SIGNATURE FOR CDR

S. 116.34, F.S. Facsimile signatures.--

(1) SHORT TITLE.--This act may be cited as the "Uniform Facsimile Signature of Public
Officials Act."

(2) DEFINITIONS.--As used in this section:

(a) "Public security" means a bond, note, certificate of indebtedness, or other obligation for the
payment of money, issued by this state or by any of its departments, agencies, public bodies, or
other instrumentalities or by any of its political subdivisions.

(b) "Instrument of payment" means a check, draft, warrant, or order for the payment, delivery,
or transfer of funds.

(c) "Instrument of conveyance" means an instrument conveying any interest in real property.

(d) "Authorized officer" means any official of this state or any of its departments, agencies,
public bodies, or other instrumentalities or any of its political subdivisions whose signature to a
public security, instrument of conveyance or instrument of payment is required or permitted.

(e) "Facsimile signature" means a reproduction by engraving, imprinting, stamping, or other
means of the manual signature of an authorized officer.

(3) USE OF FACSIMILE SIGNATURE.--Any authorized officer, after filing with the Department
of State his or her manual signature certified by him or her under oath, may execute or cause to
be executed with a facsimile signature in lieu of a manual signature:

(a) Any public security or instrument of conveyance, provided that at least one signature
required or permitted to be placed thereon shall be manually subscribed.

(b) Any instrument of payment.

(c) Any official order, proclamation or resolution; provided, however, that this shall not apply to
the signing of legislative bills or veto messages. Upon compliance with this act by the
authorized officer, a facsimile signature has the same legal effect as a manual signature.

(4) METHOD OF USE OF FACSIMILE SEAL.--When the seal of this state or any of its
departments, agencies, public bodies, or other instrumentalities or of any of its political
subdivisions is required in the execution of a public security or instrument of payment, the
authorized officer may cause the seal to be printed, engraved, stamped or otherwise placed in
facsimile thereon. The facsimile seal has the same legal effect as the impression of the seal.

(5) VIOLATION AND PENALTY.--Any person who knowingly, without authorization or with
intent to defraud, uses on any of the documents referred to in subsection (3), a facsimile
signature, or any reproduction of it, of any authorized officer, or any facsimile seal, or any
reproduction of it, of this state or any of its departments, agencies, public bodies, or other
instrumentalities or of any of its political subdivisions, shall be guilty of a felony of the second
degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

(6) UNIFORMITY OF INTERPRETATION.--This section shall be so construed as to effectuate
its general purpose to make uniform the law of states which enact it.

History.--ss. 1-6, ch. 63-441; ss. 10, 35, ch. 69-106; s. 69, ch. 71-136; s. 745, ch. 95-147.


                                                                                                       99
                                          ATTACHMENT F



                  CERTIFICATE FOR FACSIMILE SIGNATURE
                                (Section 116.34, Florida Statutes)


State of Florida
County of __________________

         I, __________________________________________________________ being
                                  (Print name as to be signed below)

Duly appointed as _______________________________________________________
                                 (State complete title or position)

______________________________________________________________________

Do hereby file with the Secretary of State my official signature for the purpose of

complying with Section 116.34, Florida Statutes, and do hereby certify that the

signature below is true, correct and manually subscribed by me.



         UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE
           READ THE FOREGOING OATH AND THAT THE FACTS
                      STATED IN IT ARE TRUE.


                                              _____________________________
         _________________
                                                     Signature                        Date
signed


         ___________________________________________________
                                                        Print Name as signed


         ___________________________________________________
                                                        Business Address


         ___________________________________________________


         ___________________________________________________
                                            City                            State     Zip
Code




                                                                                            100
                                  ATTACHMENT F




MAIL COMPLETED APPLICATION TO:

L66
Collins building
107 West Gaines Street
Tallahassee, Florida 32399-8250




                                                 101
                                                 ATTACHMENT F




                                               STATE OF FLORIDA
                                       OFFICE OF VITAL STATISTICS




                   LOCAL REGISTRAR’S ACCEPTANCE

I, ________________________________________hereby accept the appointment as
Local Registrar of Vital Statistics for ____________________________ County,

                                                State of Florida.

I hereby agree to discharge the duties of a Local Registrar according to Chapter 382, Florida Statutes,
rules promulgated thereunder, regulations of the Department of Health and instructions of the State
Registrar,



IN WITNESS WHEREOF, I have hereunto affixed my signature

Date ________________________________



                            Signature____________________________________________

                            _____________________County Health Department

                                     ____________________________________________________
                                     (Number and Street) (P.O. Box)

                                     ____________________________________________________
                                           (City)             (Zip Code)


Witness to Signature:

_________________________________, ___________________
                                           (Date)
DH 1233A, 10/09 (Replaces previous editions)



                                                                                                          103
                                                 ATTACHMENT F




                                         STATE OF FLORIDA
                                     OFFICE OF VITAL STATISTICS




         CHIEF DEPUTY REGISTRAR’S ACCEPTANCE


I, ________________________________________hereby accept the appointment as

Chief Deputy Registrar of Vital Statistics for ____________________________ County,

                                                State of Florida.

I hereby agree to discharge the duties of a Chief Deputy Registrar according to Chapter 382, Florida
Statutes, rules promulgated thereunder, regulations of the Department of Health and instructions of the
State Registrar. I have successfully completed Trak-IT Vital Statistics Chief Deputy Registrar Training.



IN WITNESS WHEREOF, I have hereunto affixed my signature

Date ________________________________


                                     Signature____________________________________________

                                     ____________________________County Health Department

                                     ____________________________________________________
                                     (Number and Street) (P.O. Box)

                                     ____________________________________________________
                                           (City)             (Zip Code)


Witness to Signature:

_________________________________, ___________________
                                           (Date)
(DH 1233B, 10/09 (Replaces previous editions)


                                                                                                      105
                                                ATTACHMENT G




                                         STATE OF FLORIDA
                                     OFFICE OF VITAL STATISTICS



                 DEPUTY REGISTRAR’S ACCEPTANCE


I, ________________________________________hereby accept the appointment as
Deputy Registrar of Vital Statistics for ____________________________ County,

                                               State of Florida.

I hereby agree to discharge the duties of a Deputy Registrar according to Chapter 382, Florida Statutes,
rules promulgated thereunder, regulations of the Department of Health and instructions of the State
Registrar. I have successfully completed Trak-IT Vital Statistics Chief Deputy Registrar Training.



IN WITNESS WHEREOF, I have hereunto affixed my signature

Date ________________________________


                                    Signature____________________________________________

                                    ____________________________County Health Department

                                    ____________________________________________________
                                    (Number and Street) (P.O. Box)

                                    ____________________________________________________
                                          (City)             (Zip Code)


Witness to Signature:

_________________________________, ___________________
                                           (Date)
DH 1233C, 10/09 (Replaces previous editions)




                                                                                                           107
ATTACHMENT G




               108
                                                 ATTACHMENT H
FLORIDA DEPARTMENT OF


HEALTH                                                  State of Florida
                                                Office of Vital Statistics
Section A.
             APPLICATION FOR APPOINTMENT OF SUBREGISTRAR OF VITAL STATISTICS

Funeral/Direct Disposal Establishment:_______________________________________________________________

Establishment License/Registration Number: __________________________________________________________

ADDRESS:_____________________________________________________________________________________
                 Street                          City                             Zip Code

Application is hereby made for ____________________________________________________________________
To be commissioned as a Sub-registrar of Vital Statistics located at the above-named establishment. This person is
now commissioned as a Notary Public in and for the State of Florida.

________________________________________               _________________                      __________
Signature of Funeral Director/Direct Disposer in charge F License Number                      Date Signed


Section B.
                                         APPLICANT INFORMATION

Have you previously been commissioned as a sub-registrar in Florida?    Yes _______ No _______

If yes, give name of establishment, county, and date of commission:

________________________________________                ____________________          ______________________
             Establishment Name                               County                       Date of Commission

Have you ever been commissioned under another name?                Yes __________ No ___________

If yes, give name under which previously commissioned: _____________________________________________

Has your commission ever been revoked?                                   Yes __________ No ___________

Has disciplinary ever been taken against you by this department?   Yes __________ No ___________

If yes, give explanation for either
____________________________________________________________________________________________

____________________________________________________________________________________________


Section C.
                                           TRAINING INFORMATION

Sub-registrar training given by: _______________________________ County_____________________
                                       Name of Trainer                               Title

Date training completed:          ____________________________

                                                                                                               109
                                                  ATTACHMENT H
Section D.

                                       SUBREGISTRAR’S ACCEPTANCE


I, _________________________________ , hereby accept the appointment as Sub-registrar of Vital Statistics for all
districts, State of Florida. I hereby bind myself to discharge the duties of a sub-registrar according to Chapter 382,
Florida Statutes, and to observe all rules and regulations of the Department of Health and instructions of the State
Registrar.

IN WITNESS WHEREOF, I have hereunto affixed my signature, on this date:__________________________




                                                 Signature: ___________________________________________

                                                 Date my commission expires: ___________________________


                  AFFIX
             NOTARY STAMP OF
              THE APPLICANT




___________________________________________
             Witness to Signature




Section E.
                                RECOMMENDATION OF LOCAL REGISTRAR

As Local Registrar for the district in which the above-named establishment is located, I make the following
recommendation on this application:

Recommend Approval:                                      YES _________ NO ___________

Recommend Disapproval for the following reason: ______________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________



______________________________________________                           _______________________________
        Signature of Local Registrar                                             Date Signed




                                                                                                                   110
ATTACHMENT H




               111
  ATTACHMENT I




HOME BIRTHS




                 113
                           ATTACHMENT I




                      HOME BIRTH

You have notified this office of a Non-hospital/Institution birth
(home birth) that was attended by the parent or other unlicensed
individual. You have stated that the birth occurred in
__________________ County.

        Birth Certificates must be registered according to
                  Chapter 382, Florida Statutes




 PLEASE READ THE ENCLOSED IMPORTANT INFORMATION


                                                                115
                                                 ATTACHMENT I


In order to register the birth, it is necessary that the Office of Vital Statistics be able to verify that the
birth did occur in Florida, that it occurred at the place and on the date reported, and that the child for
whom the certificate is being prepared is, in fact, the child of the person who is to be shown as the
mother.



To expedite the registering of the birth, there can be a home visit by an official of the County Health
Department to verify the birth or the parents may bring the child to the County Vital Statistics Office at a pre-
appointed time (you should contact the Chief Deputy Registrar to make this appointment). It will be necessary
for the parents to provide a valid signature/picture form of identification, such as a driver’s license or
identification card issued by the state of Florida, and their social security card. It will be necessary to provide
proof of pregnancy.

A letter from a licensed physician/midwife, on letterhead stationery, is acceptable as proof of pregnancy. The
letter should include the following:
                    • Mother’s name
                    • Statement that the mother was pregnant
                    • An estimated due date
                    • Number of prenatal visits, if any

If the mother had no prenatal care, we ask that you be prepared to provide us with other types of information in
order to establish the facts and validate the birth. You may bring such things as:
                    • Letter from the employer of one or both of the parents stating that the employer was
                        aware of the pregnancy
                    • Verification may be obtained from a community or social agency that was aware of the
                        pregnancy
                    • Statement from childcare personnel, if there are other children in childcare
                    • Statement from pharmacist who provided prenatal vitamins
                    • Statement from clergy or neighbors

There are two types of verification statements; both require a valid photo ID. A sample of an acceptable
statement is included in this information packet. You may bring your witness(s) with you to your appointment
and they will complete a statement at that time or you may use the enclosed form. The person verifying the
pregnancy and/or birth should complete this form and return it to us by mail. Be sure to include copies of the
required photo ID. It is preferred that this form be notarized before it is mailed, but if a notary is unavailable,
the two witness’ statements will be acceptable.

The Department of Health’s collection of the social security number is authorized by federal law,
Public Law (PL) 105-34, section 1090.




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                                                  ATTACHMENT I

                         Florida Statute and Florida Administrative Code References

                        BIRTHS OCCURRING OUTSIDE A FACILITY—HOME BIRTHS


FLORIDA STATUTES—BIRTH REGISTRATION

382.013 Birth Registration.-A certificate for each live birth that occurs in this state shall be filed within 5 days
after such birth with the local registrar of the district in which the birth occurred and shall be registered by the
local registrar if the certificate has been completed and filed in accordance with this chapter and adopted rules.
The information regarding registered births shall be used for comparison with information in the state registry,
as defined in chapter 61.
(1) FILING. --
         (a) If a birth occurs in a hospital, birth center, or other health care facility, or en route thereto, the
person in charge of the facility shall be responsible for preparing the certificate, certifying the facts of the birth,
and filing the certificate with the local registrar. Within 48 hours after the birth, the physician, midwife, or
person in attendance during or immediately after the delivery shall provide the facility with the medical
information required by the birth certificate.
         (b) If a birth occurs outside a facility and a physician licensed in this state, a certified nurse midwife, a
midwife licensed in this state, or a public health nurse employed by the department was in attendance during
or immediately after the delivery, that person shall prepare and file the certificate.
         (c) If a birth occurs outside a facility and the delivery is not attended by one of the persons described in
paragraph (b), the person in attendance, the mother, or the father shall report the birth to the registrar and
provide proof of the facts of birth. The department may require such documents to be presented and such
proof to be filed as it deems necessary and sufficient to establish the truth of the facts to be recorded by the
certificate and may withhold registering the birth until its requirements are met.


FLORIDA ADMINISTRATIVE CODE, PART III BIRTH REGISTRATION

64V-1.006 Birth Registration; Evidence Required for Births Occurring Outside of a Facility

(2) If a birth occurs outside a facility and the child is not taken to a facility within three days after delivery, a
Certificate of Live Birth, DH Form 511, July 04, will be accepted for registration by a local registrar and state
filing by the Office of Vital Statistics if corroborated by a written statement a licensed physician or a licensed
midwife in attendance during or immediately after the birth.
(3) If a written statement referenced in subsection (2) of Rule 64V-1.006, F.A.C. cannot be obtained,
corroborating evidence or action as follows may be substituted:
         (a) Presentation of the child for whom the certificate is being filed at the DH county health department
or a home visit by an official of a DH county health department to verify the birth; and
         (b) A written statement from at least 2 persons other than the parents affirming that to the best of their
knowledge of conditions prior to or immediately after the alleged birth that such birth did occur on the date and
the place shown on the certificate; or
         (c) If sufficient corroborating evidence cannot be obtained a delayed birth certificate may be filed under
Section 382.0195, F.S.




                                                                                                                    117
                                                             ATTACHMENT I



                                                      WORKSHEET
                                     (TO BE COMPLETED BY CDR ONLY)

The following information was received by _____PHONE _____ MAIL on: _____________                                  _____
                                                                                                          (Date)

Taken by: ______________________________________
                           (Vital Statistics staff person)

We have been notified that __________________________________________ gave birth to a
                                                        (Mother’s name)

Male ______ Female______ child on:                                                            and the child was born
                                                                (Date)
at home at the address shown below:

                                                                          ,
        (Street address)                                                      (City, County & Zip code)

This birth was reported to us by Mr./Ms                                                       who gave his/her

relationship to the child as:                                                 (mother, father, friend, neighbor, etc.) and

provided the following information:

Parents’ phone number: Home                                                   Work

Phone number of person reporting birth if different from parents’ phone



YOU HAVE MADE AN APPOINTMENT TO REGISTER THIS BIRTH AT:

TIME                                          AM/PM                           DATE

The address is:

                                                                          PHONE NUMBER




If you have questions or unable to keep your appointment, please call the above number for assistance.



                                                                                                                           118
                                                     ATTACHMENT I

                                                     STATEMENT
PLEASE TYPE OR PRINT LEGIBLY


To: County Vital Statistics Registrar


I,                                                                                                    , residing at
               (Name of person providing information)

                                                 _                                                     affirm that to
       (Current address of person providing information)

the best of my knowledge, a child was born to
                                                                       (Name of Mother)

on                                       at
               (Date)                                           (City/County where birth occurred)


       (Type & number of valid photo identification provided)

This statement is based on my personal knowledge of conditions prior to and immediately after the birth. I
acknowledge that this information will be used for filing a Certificate of Live Birth with the State of Florida
and section 382.023(1) Florida Statutes states, “…willfully furnishing false or fraudulent information affecting
a birth certificate is a felony of the third degree, punishable as provided in sections 775.082, 775.083 or
775.084, Florida Statutes.”

Signed in presence of:



               (Witness # 1 Signature)                                 (Signature of Person providing information)


               (Witness #1 Name, please print)



               (Witness # 2 Signature)


               (Witness # 2 Name, please print)



                                                                                                                      119
                                             ATTACHMENT J
Paper Type ___________                     INVENTORY LOG                    ____________ County/Unit
                                 INVENTORY OF SAFETY PAPER LOG
                                      Monthly                          Status
                                     Inventory   Inventoried    Used, Open, Sealed,
    Audit Control Number Range         Date          By        Transferred, Destroyed    Comments




                                                                                                       121
          ATTACHMENT K




E-VAULT PRINT INSTRUCTIONS




                             123
                                               ATTACHMENT K

                                  Vital Statistics E-Vault Print System


For the purpose of viewing and printing select vital statistics data or reports, the Department of Health
(DOH) has a secure website for authorized DOH employees only. That site is called E-Vault Print and the
web address is: http://hpe00ws/EVault/EVault.aspx ; Chief Deputy Registrars (CDRs) and Deputy
Registrars have access to this website.

CDRs and their deputies will find the E-Vault Print to be quick and user-friendly for obtaining birth, fetal
death and death records to be used for internal DOH projects. In counties where the Electronic Birth
Record (EBR) has been implemented, Healthy Start CHD staff can access E-Vault Print to obtain copies of
birth data and also the Infant Risk Screen, DOH 3135 form. Once EBR is implemented, CDRs and their
deputies are no longer responsible for supplying Healthy Start with the Infant Risk Screens or copies of
birth certificates. Healthy Start CHD staff will be contacted by Healthy Start headquarters staff to facilitate
their access to the website and ensure they are trained in its use. The headquarters contact person is
Felisha Dickey.

The E-Vault Print enables users to accomplish two different types of tasks. First, users can access Infant
Death, Under 500 Grams, and Fetal Death reports to support Vital Statistics data quality and monitor
county trends. Second, users can print a copy of the birth, fetal death and death data the day after the
record is registered/complete. The birth, fetal death and death records from the entire state, regardless
of county of occurrence, are available to any user through E-Vault Print. The only information required is
the event year and certificate number which is obtained from the state file number.

Using E-Vault Print to Access Reports…

Step 1 Entering the E-Vault Print System

Hold the cursor over the LINK and you should see this:
Simply hold down the CTRL key and click on the following link: http://hpe00ws/EVault/EVault.aspx




                                                                                                            124
                                               ATTACHMENT K

Step 2 Selecting the Report Creator
Highlight the radio button to select the X-LBW, Infant/Fetal Deaths Reports




 In the E-Vault Print system, select “X-LBW, Infant/Fetal Deaths Reports”, then select the report needed.
                        You will see the State File Numbers displayed on the report.

Three new reports have been recently added as indicated above: (1) Infant Death Report, (2) Under 500
Grams Report, and (3) Fetal Death Report. These reports are updated every night.

The Infant Death Report replaces the monthly report which had been mailed to the CDRs for purposes of
tracking infant deaths and also for review/analysis of their county’s infant death rate. This report has been
enhanced so that the infant death listed now includes corresponding information from the linked live birth
record. This revised report contains the Death State File Number and the Birth State File Number, in case
it is necessary to view the individual records for further information.

The Under 500 Grams Report is a new addition and displays the live birth indicating an extremely low birth
weight (< 500 grams) and also includes corresponding information from the linked death record. This
includes all births <500 grams regardless if the baby is still alive or is deceased. This should be useful for
tracking the death record, if applicable, or confirming that the baby is indeed alive. The report contains the
Birth State File Number and the Death State File Number, in case it is necessary to view the individual
records for further information.

The Fetal Death Report replaces the monthly report which had been mailed to the CDRs for purposes of
review/analysis of their county’s fetal death rate. This report has been enhanced to include additional data
fields which are of interest to the county staff. The report contains the State File Number (i.e., the Fetal
Death State File Number) in case it is necessary to view the individual records for further information.




                                                                                                            125
                                           ATTACHMENT K

Step 3 Selecting Your Report
Highlight the radio button to select your report. This example shows that the Infant Death Report has
been selected.




Step 4 Designing Your Report
Indicate the County, Year, and Month for your report. You can obtain a report for a single month or an
Entire Calendar Year by selecting “Entire Calendar Year” at the bottom of the drop-down list when
selecting the Month. Then, click OK and your report will appear.




                                                                                                    126
                                              ATTACHMENT K

Using E-Vault Print to Print Birth, Death, or Fetal Death Records for DOH Use Only…

Step 1 Identify the State File Number

Searching for a record in E-Vault Print requires the State File Number of the record. This is accomplished
by noting the state file number from the report as described above or searching e-Vitals for the state file
number (see example screen shot below). Remember, e-Vitals is for view only, you cannot print from
there. In order to print, you must go to E-Vault Print.

From the e-Vitals Search, the Event Year is the first 4 digits of the State File Number and the Certificate
Number is the last 6 digits of the State File Number. Remember, the printed copy is for internal DOH use
only and should not be provided to parents or any outside entity other than those proscribed.




                                                                                            E-Vitals
                                                                                            Search
                                                                                            Screen




                        The e-Vitals Search Screen provides the State File Number

Step 2 Entering the E-Vault Print System

Hold the cursor over the LINK and you should see this:
Simply hold down the CTRL key and click on the following link: http://hpe00ws/EVault/EVault.aspx




Step 3 Select Your Record

Once you access the web page, click on the option on the left that you want to search. The example below
shows that Individual Birth has been selected.


                                                                                                          127
ATTACHMENT K




               Enter year: 2009

               Enter 6 digit certificate number

               Click View Certificate




                                                  128
                                                ATTACHMENT K

Step 4 View Your Record

The record you have selected will appear:


                                                                           Toolbar details are explained below.




                                                                            You can view or print the birth
                                                                            data. Identifying information has
                                                                            been protected in the example.




These are the different functions available to you on the tool bar:




   Print         Export                                    Click to             Search Icon
   Icon          Icon                  Page                find total of
                                       Number              pages



Help with E-Vault Print
A link to printing tips is located at the lower left side of the screen. If you require other assistance with E-
Vault Print, please contact the Office of Vital Statistics.




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