Get Fetal Death Certificate Processing

Filling out a fetal death certificate is essential to properly document and acknowledge the loss. This guide provides step-by-step instructions to help you complete the Fetal Death Certificate Processing online accurately and sensitively.

Follow the steps to fill out the fetal death certificate online.

1. Press the ‘Get Form’ button to obtain the form and open it in the editor.
2. In Field 1, enter the name of the deceased using all capital letters. If the name is not chosen, indicate ‘Not Named’ in Field 1A or leave it blank if no name is provided.
3. In Field 4A, provide the date of birth as follows: include the month spelled out, followed by the day and year.
4. For Field 6, fill in the father’s name by entering the first, middle, and last name in the designated fields. If the father has no middle name or if the mother is unmarried, leave these fields blank.
5. In Field 7, enter the father’s date of birth, spelling out the month. If the mother is unmarried, leave this field blank.
6. In Field 8, provide the father’s place of birth. If the mother is unmarried, this field should remain blank.
7. For Field 13, enter the mother’s mailing address only if it differs from other addresses. If it is the same, leave this field blank.
8. In Fields 17 through 18B, complete the cause of death section. This must be done by a physician within 72 hours. Use a typewriter or permanent black ink, ensuring all entries are legible. Do not abbreviate or use strikeovers. Report each disease or condition that contributed to the deceased’s death.
9. In Field 17, under Part I, list the immediate cause of death on Line A, ensuring not to leave it blank. Use subsequent lines for additional causes leading to death. The final line in Part I should contain the underlying cause.
10. In Part II, report any significant conditions that contributed to the death that were not detailed in Part I.
11. For Field 18, indicate ‘YES’ if an autopsy was performed, otherwise enter ‘NO’.
12. Field 22 requires you to state whether the case was referred to a medical examiner; enter ‘YES’ for any deaths due to accidents, suicides, or homicides.
13. Fields 22 through 24 are to be filled by the medical examiner or their designate. Ensure these fields remain blank otherwise.
14. Fields 33 through 37 are reserved for local and state registrars. Leave these fields blank.
15. If needed, use Field 38 for additional entries, indicating 'SEE #58' as appropriate.
16. Review all entries carefully. Once completed, you can save your changes, download, print, or share the form as needed.

Start filling out the fetal death certificate online today to ensure the documentation is completed accurately and compassionately.