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Case Folder: Top Folder Record ID: TEST-2020-5473
Birth/Fetal Death Certificate- Infant/Fetal
Section (Record 1)
Reporting state: test
Date created: user9 7/20/2022 05:12:49
Last updated: user9 7/20/2022 15:11:46
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Record Type*
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Birth Order
Multiple Gestation
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V
V
V
Newborn (Fetus) Record Identification
State File Number
Local File Number
Date of Delivery
Time of Delivery
Newborn Medical Record Number
mm/dd/yyyy
Newborn (Fetus) Biometrics and Demographics
Birth Weight
Value (Grams or Pounds)*
Unit of Measurement
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Value (Ounces)*
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Sex
Apgar Scores
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5 Minute
Is Infant Living at Time of Report?
10 Minute
Is Infant Being Breastfed at Discharge?
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Was Infant Transferred Within 24 Hours of Delivery?
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Method of Delivery
A. Was Delivery With Forceps Attempted but Unsuccessful?
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B. Was Delivery With Vacuum Extraction Attempted but Unsuccessful?
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C. Fetal Presentation at Birth
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| File Type | application/pdf |
| File Title | MMRIA Forms |
| Subject | MMRIA, Forms |
| Author | Gyan Chandra, CDC |
| File Modified | 0000-01-01 |
| File Created | 0000-01-01 |