The CDC US Standard Certificate of Live Birth is a record form used to document a child’s birth in the United States. This form is issued by the Centers for Disease Control and Prevention’s National Center for Health Statistics. It captures detailed information about the birth event, including the date, place of birth, and information about the parents. The form ensures uniform data collection across different jurisdictions, which aids in maintaining consistent national birth statistics. CDC US Standard Certificate of Live Birth provides legal proof of identity and age, essential for registering for school, obtaining a driver’s license, and proving eligibility for benefits.
Other PDF Forms
You can find more editable PDF forms accessible with our tool. Down below, we listed a number of the more popular forms included in this category. Besides that, keep in mind that you can upload, fill out, and edit any PDF at FormsPal.
The structure of the form implements its purposes. So, it contains sections about the newborn, the mother, the father, and the doctor (or the person who fills out the document if the birth is not in a hospital). Please note that the deadline for filling out the form is 72 hours after delivery.
The filler might record the data either in paper or electronic form. The second one is faster to use because it does not require to be printed, so errors are easier to fix. To complete an e-form, use our online form builder. This is a simple fill-in tool that works even with such complex documents as the CLB.
Commonly, the doctor of the facility where the birthplace was prepared the Certificate. Let us remind you that if the birthplace was not in a hospital or clinic, the mother’s attending physician must fill out the paper. In extreme cases, if the specialist is not around, the form is filled out by any person who witnesses the birth. Below we have compiled a list of tips on how to fill out the form.
Enter the Primary Data on the Newborn.
In boxes 1 to 7 of the first section, enter the identifying information about the infant. Specify the name, sex, exact hour and minutes of birth, the name of the facility or address where the baby was born, the city, and the country.
Identify the Mother.
In the boxes from 8a to 9g, specify the information about the mother that identifies the individual. This is their name, date, and place of birth (including the country and city), ZIP-Code (the index of the place of residence). In the last box, specify whether the birth took place inside the city or not.
Identify the Father.
In the boxes from 10a to 10c, identify the father. Here you need to enter the minimum data such as their name, date, and birthplace.
Enter the Data on the Certifier.
In the last boxes of the first Section, identify the person who certifies the CLB. It may be the same person as the attendant, but the match is not needed. “M.D.” means “doctor of medicine,” “D.O.” means “doctor of osteopathy,” CNM/CM stands for “certified nurse-midwife” or “certified midwife.” If you fill out the box “other,” specify the position of the individual or his relation to the woman in labor.
Specify the Contact Details.
In the second Section, provide information about the mother’s postal address. Enter the marital status of the mother and the social security numbers of both parents. Enter the insurance number for the child.
Detail the Info on the Mother.
In boxes 20 to 22 of the fourth Section, check the appropriate item. Determine the mother’s education, origin, and race.
Detail the Info on the Father.
The next part indicates similar data about the newborn’s father. Again, if you choose the box “other,” you need to clarify the information on the line near the box.
Provide Information on the Medical Facility.
In the last part of the fourth Section, point out the information about the facility or another birthplace, identify the attendant or midwife. Also, specify what medical reasons the mother was taken to the hospital or clinic. Please note the lines to fill in on the margins of this section.
Determine Mother’s Health.
The fifth section of the Certificate of Live Birth requires data on the mother’s health, including the course of previous pregnancies and births. Here you need to give data on her physical parameters and lifestyle.
Clarify the Medical Circumstances of Childbirth.
This part covers the details of the infant’s delivery process, such as risk factors during pregnancy, the beginning and duration of labor, the delivery method, medications that the doctor used, infections that the mother has if any. In the boxes from 41 to 47, select the correct items.
Provide Medical Information on the Child.
The last sixth section deals with the condition of the infant(s). Here, enter primary data about their physiology and the abnormality, if any. Also, indicate whether any medications were received by the child.
Thus, the Certificate of Live Birth provides the initial data about the child (children) and their parents. As you can see, it is both identifying and medical information. The form has the data needed for receiving the Birth Certificate but is only a registration form and does not prove identity itself. Therefore one must submit it to the Department of Health and Vital Statistics to receive the Birth Certificate. This latter gives the newborn the right to obtain a Passport in the future.
