Get Al Adph-hs-11-m 2014-2026

The AL ADPH-HS-11-M form is essential for documenting a child's birth, ensuring accurate information for the birth certificate. This guide will walk you through each section of the form, making the process straightforward and clear.

Follow the steps to complete the AL ADPH-HS-11-M form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the room number, mother’s medical record number (MRN), mother’s name, child’s date of birth, and child’s MRN. If applicable, indicate if there were multiple deliveries.
3. Provide the legal name for your baby as it should appear on the birth certificate. Avoid including any nicknames.
4. Complete the mother's information by entering her current legal name, mailing address, and physical address. Clarify if the physical address is the same as the mailing address.
5. Enter the mother’s date of birth and place of birth, specifying the state, territory, or country.
6. Indicate the highest grade completed by the mother and select the appropriate options regarding her ethnic origin and race.
7. List the mother's Social Security number and details regarding her occupation and industry.
8. Record the mother's pre-pregnancy weight, weight at delivery, and height information. Respond to questions regarding WIC, tobacco use, and the desire for a Social Security number for the child.
9. For the father's information, provide his current legal name, date of birth, place of birth, Social Security number, and details about his occupation and industry.
10. Indicate the father's education level and ethnic origin, followed by his race, similar to how the mother’s information was provided.
11. Both parents need to sign and date the form to certify that the information provided is accurate.
12. If there were multiple births, complete the additional pages for each subsequent child.
13. Once all sections have been filled accurately, save your changes, download the document, print it, or share it as needed.

Complete the AL ADPH-HS-11-M form online to ensure proper documentation of your child's birth.