BIRTH RECORDER TRAININ 1 You Are A

BIRTH RECORDER TRAININ

1. You Are A Critical Partner! 2. Data Quality Importance 3. Birth Registration Laws 4. Screen by screen discussion of EBRS 5. Establishing Paternity 6. Fetal/Stillbirth Death Certificates

Vital Records statistics are essential in evaluating, planning and implementing programs in public health to benefit Arizona families. Data Quality

Each month Vital Records generates several reports to identify inconsistent or inaccurate information. Vital Records may contact you for correction or verification if questionable data is reported.

Ensure Accurate, Complete, and Timely Data Some examples of potential inaccuracies: – Age of Mother vs. Education – Age of Mother vs. Born Alive Now Living – Duplicate Births Registered – Late Facility Transmission

Definition: Live Birth A. R. S. § 36 -301. 3 "Birth" or "live birth" means the complete expulsion or extraction of a product of human conception from its mother, irrespective of the duration of the pregnancy, that shows evidence of life, with or without a cut umbilical cord or an attached placenta, such as breathing, heartbeat, umbilical cord pulsation or definite voluntary muscle movement after expulsion or extraction of the product of human conception.

Birth Certificate Registration A. R. S. § 36 -333. B B. If a birth occurs at a hospital, the chief administrative officer of the hospital or that person's designee shall: 1. Obtain the information for a birth certificate, including signatures and social security numbers required by rule. 2. Fill out the birth certificate. 3. Submit the birth certificate for registration to a local registrar, a deputy local registrar or the state registrar. 4. Maintain a copy of the evidentiary documents used to fill out the birth certificate for ten years after the date of submission.

Birth Certificate Registration A. R. S. § 36 -333. A A. Within seven days after a child's birth in this state, a person shall submit to a local registrar, a deputy local registrar or the state registrar, a birth certificate for registration according to rules adopted pursuant to this chapter. The birth certificate shall be submitted physically or electronically through the state designated electronic registration system.

When must the Hospital Register the Birth? Hospital Registers the Birth if the: • Child is born in the hospital • Child is born on the way to the hospital • Child is born at home, but the placenta is delivered en route to, or at the hospital

The “fillable” Certificate of Live Birth form Ø To be used by all hospitals not using the Electronic Birth Registration System (EBRS) Ø To be used by all hospitals for births 1 year and older

What Happens if a Birth is Not Registered Within a Year? The hospital or birthing facility must submit the following to the State Office of Vital Records: 1. Completed Certificate of Live Birth form 2. Supporting medical records 3. If mother is not married, proof of paternity if father is to be added (Acknowledgment of Paternity) 4. A letter from the hospital supervisor, manager or director stating the reason why the birth is being registered late

Before submitting a completed Certificate of Live Birth form, please review it for completeness and accuracy. -See instruction guide.

Hospital Worksheet Checklist PLEASE MAKE SURE: ü The worksheet has an accurate description in English for each field ü The worksheet is completely filled out, readable and accurate ü Dates should follow the format: month/day/year ü Informant signed the worksheet, verifying the information was accurate ü In the birth recorders absence, back-up staff is available to obtain all needed information for the birth recorder

Entering the Birth Certificate into the EBRS System

Child’s Name Enter the child’s name. If the informant reports what appears to be a dual first name, verify it. MARY JO DOUGH

Child’s Name Acceptable Punctuation: • space • hyphen • apostrophe • some special characters (See Q. A. Birth Bulletin #8) LOUIE CJ RENE’ O’BRIAN-GARCIA XIV

Child’s Name Acceptable Suffix: • Roman numerals • Jr Numbers are not acceptable, e. g. , 2 nd, 3 rd, etc. LOUIE CJ RENE’ O’BRIAN-GARCIA XIV

Enumeration at Birth Per parental request, NOT NAMED choose “Yes” for child to receive a Social OR Security card, but… UNKNOWN Do not select “Yes” if the: • Child is not named • Sex is “Unknown” O’BRIAN-GARCIA NO

Attendant: Person physically present and responsible for delivering or supervising the delivery of the child

Attendant: If the title is not in the menu, choose “Other” and enter title. Do not choose “Other” to enter an existing menu choice (e. g. , M. D. , Midwife, etc. ) *Choose MIDWIFE from the menu if the attendant is a licensed midwife (LM, CPM, etc. )

Informant: Person providing the mother’s personal information. Generally, it is the mother.

Enter mother’s complete legal name and maiden name (they can be the same)

Do not enter a continent or area containing several countries, e. g. , Africa, South America, Europe, etc.

Enter mother’s “usual” residential address. If, for example, she lives in Mexico, but is visiting or temporarily staying in the U. S. , her Mexico address must be entered.

Excludes the birth of this child Miscarriage, abortion, fetal demise, ectopic pregnancy

Birth order if a Twin: Twin A = 1 Twin B = 2 Was mother transferred from another birthing facility to give birth at your hospital? Was newborn transferred to another hospital after birth?

Why are these three areas inaccurate or inconsistent? 1 2 3

CHOICES

Mother Not Married Ø Choosing “No” or “Unknown” will not allow you to add a father Ø Choosing “Yes” means you can add the father with an Acknowledgment of Paternity

Mother Is Married Acknowledges mother was married, but she refused to give husbands information

Mother Is Married = Choosing “Yes” allows you to open the Paternal Information screen.

To add biological father when mother is married ity W + e aiv r of ern Pat or Dissolution of Marriage Ø Choose “Yes, Divorced” or “Yes, Waiver” if mother was married and a either Waiver of Paternity Affidavit or certified court order rebutting paternity is attached with the AOP.

Each section must be either checked, or the condition, if not included in the choices, must be entered in the “Other” field

Use a 3 -digit format for this field. If there was weight loss, enter “ 000”.

IN CO NS IS TE NT Again, watch for inconsistent information. This birth should not be transmitted until this issue is resolved.

Data Verification Form

Data Verification Form v Reduces hospital corrections v A copy should not be given to the parent if needed for insurance or other official business purposes v Cannot be used to support a hospital correction letter

Acknowledgment Of Paternity

Mary Mc. Dowell Susie Witness x 09/25/11 = 09/25/11 John Wannabe Susie Witness x 09/29/11 Susie Witness 123 4 th St. , Phoenix, AZ 85008 If child was not born at your hospital write: Completed by -Your Hospital Name

AOP can be printed from EBC for newborns

Information entered in EBC will populate the corresponding fields on the Acknowledgment of Paternity form

AOP can also be completed with a manual or fillable form for children up to 18 yrs old DES WEBSITE AOP Form

When using the Acknowledgment of Paternity manual or fillable form: Names, places of birth, dates of birth and mother’s Social Security Number, must match the child’s current birth record. =

Acknowledgment of Paternity v Voluntary v No duress, threat or coercion v Same validity as court-ordered paternity v Genetic Testing not required v Minors can complete without parental consent

Robin Lynn Howell Phoenix, Maricopa, AZ 6 -18 -07 Good Joseph's Hospital AOP Checklist v Ask for I. D. Lynn Robin Garcia Terry Robin Howell 1 -19 -68 123 -45 -6789 602 123 -4567 Wauwatosa, WI U. S. A. 123 4 th St, Phoenix, AZ 85016 Wal-Mart Cashier Don NONE Juan 602 123 -4567 123 4 th St, Phoenix, AZ 85016 X X Garcia Hoboken, N. J. K-Mart 6 -12 -67 U. S. A. Maintenance Mexico x x Lupe De Loop 123 Marshmallow Lane, Phoenix, AZ 85099 X 123 Marshmallow Lane, Phoenix, AZ 85099 v Use black ink (preferably) v All fields completed v No erasure, white-out, multiple cross-out’s or write-over's

Robin Lynn Howell Phoenix, Maricopa, AZ Lynn Robin 6 -18 -07 Good Joseph's Hospital v Signatures must match the parents’ names Garcia Terry Robin Howell 1 -19 -68 123 -45 -6789 602 123 -4567 Wauwatosa, WI U. S. A. 123 4 th St, Phoenix, AZ 85016 Wal-Mart Cashier Don NONE Juan 602 123 -4567 123 4 th St, Phoenix, AZ 85016 X X Garcia Hoboken, N. J. K-Mart 6 -12 -67 U. S. A. Maintenance Mexico x x Lupe De Loop 123 Marshmallow Lane, Phoenix, AZ 85099 AOP Checklist 123 Marshmallow Lane, Phoenix, AZ 85099 v Parents cannot witness each other’s signature v Each parent can have their individual signatures witnessed on different days v Either the same witness or different witnesses can be used for each individual parent v Witnesses must sign and print their name in the provided area v The witnesses’ complete business address must be included X v Parent and witness/notary signature dates must match

Robin Lynn Howell Phoenix, Maricopa, AZ Lynn Robin 6 -18 -07 Good Joseph's Hospital Garcia Terry Robin Howell 1 -19 -68 123 -45 -6789 602 123 -4567 Wauwatosa, WI U. S. A. 123 4 th St, Phoenix, AZ 85016 Wal-Mart Cashier Don NONE Juan 602 123 -4567 123 4 th St, Phoenix, AZ 85016 X X Garcia Hoboken, N. J. K-Mart 6 -12 -67 U. S. A. Maintenance Mexico x x Lupe De Loop 123 Marshmallow Lane, Phoenix, AZ 85099 X 123 Marshmallow Lane, Phoenix, AZ 85099 AOP Checklist v For multiple births, use a separate AOP for each live birth v “Power of Attorney” cannot be used for signatures v The accompanying Spanish copy is for reference only

Was mom married to a man other than the biological father?

The attached certified Divorce Decree or other Court Order states the child is not the husband’s or. . .

A Waiver of Paternity Affidavit is attached

Waiver of Paternity Affidavit ü A waiver is required if mom is married or divorced less than 10 months and another man is the biological father. ü The waiver is valid only when submitted with an Acknowledgment of Paternity ü Use one per child

When is a Waiver or Court Order Needed? If the mother of a child is married at the time of conception or birth, or was divorced less than 10 months prior to the child’s birth, the law presumes the (ex)husband is the legal father (unless the court states otherwise in the finalized divorce decree or other court order) D I V O R C E MARRIED 10 Months B I R T H Ex-Husband is the “Legally Presumed Father” WAIVER NEEDED

Parent’s must read their “Rights and Responsibilities”

Rights and Responsibilities By Federal mandate you are required to audibly convey these rights and responsibilities to all parents signing an Acknowledgment of Paternity. • Signing this form is voluntary. • This is a legal document that has the same force and effect as a judgement of the superior court. • You are acknowledging you are the biological parent of the child named on the Acknowledgment of Paternity. • By signing this Acknowledgment you are giving up your right to a court hearing to determine paternity as well as the right to have genetic testing done to determine the parentage of this child. • Signing this Acknowledgment will result in the legal determination of paternity that shall impose a duty of support pursuant to A. R. S. § 25 -501. • This paternity determination is not a custody order but provides a basis for determining issues related to custody and visitation and affords the parents all rights and responsibilities provided by Arizona law. • If either of you change your mind after signing the Acknowledgment, you must complete an Affidavit of Paternity Rescission to cancel the declaration of paternity within 60 days from the date of the last notarized signature on the Acknowledgment and send it to the Hospital Paternity Program pursuant to A. R. S. § 25 -812.

After completed, both must be sent together to the Hospital Paternity Program

HOSPITAL CORRECTION LETTERS

Hospital’s can correct a birth record they’ve registered Good Joseph’s Hospital The Correction Letter must: ion ct rre er Co ett L • Contain the hospital letter head • Be signed by the birth recorder W rks o et he • Properly identify the child with name and date of birth • State the correction to be made • Include a copy of the hospital worksheet that supports the correction that the mother signed.

Note: Correction letters for this field will not be accepted by Vital Records offices. The parent must contact SSA to obtain a SS number/card.

SURROGATE BIRTHS Birth Certificate Registration A. R. S. § 36 -334. A A. A person completing a birth certificate shall state the name of the woman who gave birth to the child on the birth certificate as the child's mother unless otherwise provided by law or court order. • The court order must be submitted to the hospital within 7 days of the child’s birth • The hospital will only add parental information on the maternal or paternal information (demographic) screens • The hospital will fax a copy of the court order to the State Office of Vital Records • If a court order has not been submitted within 7 days of the child’s birth, the birthing mother shall be placed on the birth certificate.

FOUNDLING Birth Certificate Registration Child left with a Safe Haven Provider (e. g. , a hospital) A foundling is a newborn infant (up to 72 hours old) that is left with a safe haven provider Ø The hospital shall contact Child Protective Services (CPS) Ø The hospital or CPS social worker will complete fields 1 -9 on the Foundling Worksheet Ø The CPS social worker shall complete fields 10 -12 on the Foundling Worksheet Ø The hospital forwards the Foundling Worksheet to the State Office of Vital Records for registration

Foundling Worksheet/Report Hospital completes CPS completes

DEATH CERTIFICATES

There are 3 types of death certificates Death Certificate (born alive) Fetal Death Certificate (not born alive) Birth Resulting in Stillbirth (not born alive)

We will be discussing the following 2 types: Fetal Death Certificate (not born alive) Birth Resulting in Stillbirth (not born alive)

FETAL DEATH National Center for Health Statistics • Definition: Fetal death is a death prior to the complete extraction or expulsion from its mother of a product of human conception, irrespective of the duration of pregnancy; the death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.

Legal Definition A. R. S. § 36 -329 Fetal death certificate registration A. A hospital, abortion clinic, physician or midwife shall submit a completed fetal death certificate to the state registrar for registration within seven days after the fetal death for each fetal death occurring in this state after a gestational period of twenty completed weeks or if the product of human conception weighs more than three hundred fifty grams.

CERTIFICATE OF FETAL DEATH v Part I: Personal & Statistical Info (1 -16) v Part II: Medical Cause of Death (17 -24) v Part III: Disposition & Registrar (25 -38) v Part IV: Medical & Health Data (39 -58)

Part I: Personal & Statistical Information USE ALL CAPS - PREFERABLY “TYPE” NOT NAMED MALE SMITH TWIN SECOND APRIL 1, 2008 • 1. Unnamed = “Not Named”, not “Baby Boy/Girl”; No abbreviations • 2. Male/Female/Unknown – No abbreviations or symbols • 3 A. Specify single, twin, etc. – No abbreviations • 3 B. Leave blank if single – check hour of birth for correct multiple birth order • 4 A. Enter full name of month; example: 12: 01 a. m. = new day • 4 B. Prefer military time 2357

Part I: Personal & Statistical Information YAVAPAI PRESCOTT MARTIN JAMES YAVAPAI REGIONAL MEDICAL CENTER SMITH MAY 31, 1970 ARIZONA • 5 A/B. If birth was in moving conveyance en route, enter your hospital’s county & city • 5 C. If a hospital or birthing center do not use acronyms • 6 A-C. Legal name. If not married, no AOP needed to add father’s name • 7. Full name of month; leave blank if no father listed • 8. U. S. State or territory or country if outside of the U. S.

Part I: Personal & Statistical Information MARY ARIZONA MCREADY YAVAPAI JANUARY 14, 1980 PRESCOTT PUERTO RICO 86301 • 9. Mother’s name on her birth certificate; if no mid name, leave blank • 10. Full name of month • 11. U. S. State or territory or country if outside of the U. S. • 12 C. If rural area, name commonly used for the area; or use town name where mail service originates

Part I: Personal & Statistical Information Green trailer ½ mile east exit 284 off I-10 -or longitude/latitude Sue Jones, birth recorder x P. O. BOX or actual mailing address or “SAME” for Mary Mc. Ready Mother APRIL 2, 2008 • 12 E. Street address or RFD; No P. O. Box; Report street-type designation (St. , Rd. , Ave. , etc. ); Use directional value (North, S. , N. W. , etc. ) or descriptive designation • 13. If different from residential address; P. O. Box is acceptable; If same, enter “SAME” • 14 A. Must use legal name signatures, birth recorder can sign in behalf of informant • 16. Must not be before the date of delivery

Part II: Medical Cause of Death INTRAUTERINE FETAL DEMISE FETAL UNKNOWN FETAL SPINA BIFIDA MYRON JOHNSON M. D. x M. D. APRIL 2, 2008 • 17. Designated by the medical opinion of the medical certifier or medical examiner; Specify fetal or maternal cause • Part II – [Not numbered field] Spina Bifida is an example that should correspond to # 58 • 19. Attendant’s name typed here • 21. Date must not be before delivery date • 22 -24. Medical examiner’s information, same type of description as fields above

Part II: Medical Cause of Death INTRAUTERINE FETAL DEMISE FETAL UNKNOWN FETAL SPINA BIFIDA x PHYSICIAN REFUSED TO SIGN • 19. If physician refuses to sign leave blank. (if under 20 weeks), then enter… • 19 A. “PHYSICIAN REFUSED TO SIGN” • 20. & 21. Leave blank

Part III: Fields Disposition & Registrar FUNERAL HOME COMPLETES THIS SECTION UNLESS THE HOSPITAL DISPOSES OF THE FETAL REMAINS DISPOSAL 04/03/08 Yavapai Regional Medical Center, Prescott, AZ Yavapai Regional Medical Center + complete street address, city and state Sue Jones, birth recorder • 25. “DISPOSAL” – If hospital disposes of the fetal remains • 26. Enter month day and year of date of disposition • 27. If hospital disposes of the fetal remains, enter full name of hospital and location • 28 -29. Cremation must be authorized by the medical examiner • 30. If hospital disposes of the fetal remains, enter full name of hospital and street address • 31. If hospital disposes of the fetal remains, the birth record signs & types & includes title • 32 -38 Hospitals leave this blank, State or County offices complete this section

Part IV Medical & Health Data Father Mother NAVAJO NO WHITE MEXICAN NO JUNE 1, 2007 12 4 22 WEEKS 3 rd CARPENTER CONSTRUCTION 355 GRAMS x 12 HOMEMAKER OWN HOME BEFORE YES 1 0 0 01/1999 • 39. Specify American Indian (enter one primary tribe) white, black, etc. • 40. Hispanic origin of parents • 41. Highest competed grade • 44. Fetal Death Certificate must be submitted if 20 weeks or greater gestation • 45. Fetal Death Certificate must be submitted if less than 20 weeks gestation, but weight is greater than 350 grams • Complete unnumbered “Pregnancy History” section to the right

Part IV Medical & Health Data x x x 20 6 22 x This section is usually related to the cause of death

Certificate of Birth Resulting in Stillbirth In 2001 the Arizona Legislature established a new certificate entitled "Certificate of Birth Resulting in Stillbirth”. This new certificate became available from the Office of Vital Records beginning August 9, 2001.

Certificate of Birth Resulting in Stillbirth A Certificate of Birth resulting in Stillbirth certificates acknowledges a stillborn baby's name and brief existence.

Certificate of Birth Resulting in Stillbirth History When Dr. Joanne Cacciatore's daughter Cheyenne was born, the family never received a birth certificate, only a fetal death certificate. There would be no record of Cheyenne's birth anywhere because she never took a breath outside of her mother’s body. In other words, it was as if the child never existed. So, Dr. Cacciatore and members of her foundation created the MISSing Angels Bill to make sure that every baby who is born still in the United States is recognized with a Certificate of Birth Resulting in Still Birth. Cheyenne was the first stillborn baby in the U. S. to receive this certificate.

A. R. S. § 36 -330. Certificate of birth resulting in stillbirth; requirements A. In addition to the requirements of section 36 -329, the state registrar shall establish a certificate of birth resulting in stillbirth on a form approved by the state registrar for each fetal death occurring in this state after a gestational period of at least twenty completed weeks. This certificate shall be offered to the parent or parents of a stillborn child. B. A certificate of birth resulting in stillbirth shall meet all of the format and filing requirements for birth certificates prescribed in section 36 -333. C. The person who prepares a certificate pursuant to this section shall leave blank any references to the stillborn child's name if the stillborn child's parent or parents do not wish to provide a name for the stillborn child. D. Notwithstanding subsections A and B of this section, the certificate of birth resulting in stillbirth shall be submitted to the designated registrar within seven days following the delivery and before the cremation or removal of the fetus from the registration district.

MORTIMER x SMITH SINGLE YAVAPAI MARTIN 4 PRESCOTT JAMES SMITH MARTIN YAVAPAI 1313 MOCKINGBIRD LANE 2008 3: 57 x YAVAPAI REGIONAL MEDICAL CENTER MARY ARIZONA 1 ARIZONA 5 31 1970 3 14 1980 PUERTO RICO PRESCOTT 86301 MOTHER APRIL 1, 2008 x Sue Jones, birth recorder for Mary Martin MYRON JOHNSON MD APRIL 1, 2008

Certificate of Fetal Death To be submitted to the state or county registrar within 7 days of the delivery Ø 20 weeks and over; Hospital must submit a fetal death certificate regardless of weight (stillbirth certificate may also be submitted with it) Ø More than 350 grams; Hospital must submit a fetal death certificate regardless of gestational age Ø 350 grams and under or under 20 weeks; Hospital may submit a fetal death certificate, -if parents request it Certificate of Birth Resulting in Stillbirth To be submitted with the Certificate of Fetal Death to the state or county registrar within 7 days of the delivery Ø 20 weeks and over; Hospitals shall offer it to parents. A stillbirth certificate may be created regardless of weight Ø Under 20 weeks; Under no circumstances should a stillbirth certificate be created

A. R. S. § 36 -326. B B. Human remains moved from a hospital, nursing care institution or hospice inpatient facility must be accompanied by a form provided by the hospital, nursing care institution or hospice inpatient facility authorizing the release of the human remains. The form shall contain the information required in rules adopted pursuant to this chapter.

7 DAYS TO REGISTER FROM DELIVERY The Process… Hospital Completes Fetal + Stillbirth Certificate + Human Remains Release form to release fetal remains to the funeral home. Funeral Home Obtains disposition-transit permit from County or State Vital Records County Vital Records Fetal death certificates resides with participating county office for up to 30 days, then is sent to the State Vital Records vault State Vital Records Fetal death certificates archived in the vault Or Hospital Disposes Contacts County Vital Records for Disposition. Transit Permit if 20 weeks or over

Conclusion • Importance of quality data • Importance of timeliness • Importance of continued communication