Get Fl Dh 428 2016-2026

The FL DH 428, also known as the Florida certificate of fetal death, is a crucial document for recording fetal deaths. This guide will provide clear, step-by-step instructions on how to complete the form efficiently online, ensuring that all necessary information is accurately captured.

Follow the steps to fill out the FL DH 428 correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In section 1, enter the name of the fetus using first, middle, last, and suffix as applicable.
3. In section 2, input the date of delivery in the format of month, day, and year.
4. Section 3 requires you to indicate the sex of the fetus, selecting 'M', 'F', or 'Unknown'.
5. For section 4, provide the weight of the fetus either in pounds and ounces or grams, with a preference for grams.
6. Section 5 asks for the time of delivery to be recorded in a 24-hour format.
7. In section 6, enter the county where delivery occurred.
8. Provide the name of the facility in section 7 and the city or town of delivery in section 8.
9. Section 9 requires checking the appropriate box for the place where delivery occurred, such as hospital or home delivery.
10. Fill in sections 10a and 10b with the mother’s/parent's name and prior name if applicable.
11. Section 11 requires the mother’s/parent's date of birth, while section 12 asks for their birthplace.
12. In sections 13a to 13g, provide the mother's/parent's residence details, including state, county, city, street address, apartment number, zip code, and whether inside city limits.
13. Sections 14 to 16 pertain to the father's/parent's information, requiring name, date of birth, and birthplace.
14. In sections 17a and 17b, enter the license number and obtain the signature of the funeral service licensee.
15. Fill in sections relating to the funeral facility's name, mailing address, and place of disposition.
16. Complete sections 22 and 23 regarding the method of disposition and certifier details.
17. Section 34 requires identifying the initiating cause(s) or condition(s) leading to fetal death.
18. In the final steps, review the completed form, and ensure all fields are completed accurately before saving changes, downloading, printing, or sharing the form as needed.

Complete the FL DH 428 online today to ensure accurate documentation of fetal death.