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Get Adobe PDF (100Kb/2pgs) - Minnesota Department Of Health - Health State Mn

Minnesota Department of Health - Office of the State Registrar - MN VRV2000 Input Form Report of Fetal Death 1a Fetus First Name 1b Fetus Middle Name 3 Time of Delivery 2 Date of Delivery 7 Place of Delivery Hospital 4 Sex Residence 1c Fetus Last Name 5 Plurality - Single Twin etc. Enroute 8 Facility Name If not institution give street and number Clinic/Doctor s Office 19 SSN of Parents 10 City or Township of Delivery 16 Date of Birth 17b State 1.

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