Get Worksheet For Out-of-hospital Births - City Of Berkeley - Ci Berkeley Ca 2020-2025
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How to fill out the worksheet for out-of-hospital births - City of Berkeley online
Filling out the worksheet for out-of-hospital births in Berkeley is an essential step in registering your child’s birth. This guide provides a clear and supportive walkthrough to help you navigate each section of the form online, ensuring you provide all necessary information accurately.
Follow the steps to complete the form online.
- Press the ‘Get Form’ button to access the worksheet for out-of-hospital births and open it in your preferred editing tool.
- Begin with the child's information section. Fill in the child's first name, middle name, and last name. Indicate the child's sex and select one birth option. Enter the date and time of birth, and specify the place of birth, including the street address, city, county, and zip code.
- Complete the father or parent’s information section. Provide their first name, middle name, last name, state of birth, and date of birth.
- Next, fill out the mother or parent’s information section with their first name, middle name, last name at birth, state of birth, and date of birth.
- Provide the confidential information for public health purposes by listing the race of both parents, selecting whether they are Hispanic, usual occupation, usual kind of business or industry, education completed, and date last worked. This section also includes collecting their social security numbers.
- In the medical data section, indicate whether the mother received WIC benefits, record the average number of cigarettes smoked before and during pregnancy, the mother’s prepregnancy and delivery weights, height, and APGAR scores at 1, 5, and 10 minutes.
- Complete the pregnancy history section by entering the number of live births and other terminations, the date of the last live birth, and the principal source of payment for prenatal care and delivery.
- Address any complications and procedures of pregnancy and labor, as well as abnormal conditions related to the newborn. Use the attached worksheets for guidance on entering appropriate codes.
- At the end of the form, parents will need to sign the affidavit of birth information. Make sure that the information provided is true and correct. Both parents should print their names, sign, and include the date signed and a phone number.
- After completing the form, review all entered information for accuracy. You can save changes, download, print, or share the completed form as required.
Start completing your forms online today to ensure a smooth registration process for your child's out-of-hospital birth.
In California, you can request birth notes from the hospital where the birth occurred or through your healthcare provider. This request may require submitting a form and providing identification to verify your identity. If you are using the Worksheet For Out-of-Hospital Births - City Of Berkeley - Ci Berkeley Ca, you might have an easier time ensuring you have all necessary information before making your request.
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