introduction - avssintroduction the implementation of an automated system to accurately capture and...

CALIFORNIA BIRTH CERTIFICATE SYSTEM PAGE 1 USER MANUAL

INTRODUCTION The implementation of an automated system to accurately capture and record birth data necessitates sending large amounts of information from the counties to the Office of Vital Records (OVR). For this data to be usable, it must be sent in a form compatible with the vital statistics data processing system. This manual describes the requirements of the OVR in order for the county to transmit birth data in electronic form. Also available is the Handbook for Birth and Death Registration that provides instructions for the completion and registration of birth and death certificate forms.

1/07 INTRODUCTION


EDIT SPECIFICATIONS

Data Element Name given to an item on the birth certificate (VS-10).

Definition Explanation of what the data element signifies.

Field Number Where the data element appears on the birth certificate (VS-10)

Field Length Maximum number of alpha/numeric characters required (EDP Record) for

this data element on the EDP file. (EDP file is the Electronic Data Processing file transmitted to OVR. It is also referred to as an electronic file.)

Record Position Field location of the data element on the EDP file. (EDP Record)

Edit Criteria Valid entries that are required for this data element.

Validation Required

A data element or data relationship that has a questionable entry must be validated. Questionable entries are those that are unlikely but possible. For example, if the sex of a child is entered as “undetermined” on the paper certificate (and coded as “9” on the electronic version of the record), all available sources of information must be checked to validate that the entry of undetermined is correct. The sources include, but are not limited to, questioning the parent or informant, referring to labor and delivery logs and/or medical charts, questioning the physician or other attendant to the birth, etc. Each birth record requiring validation must contain the following information:

• Field number(s) of the entry (entries) requiring validation • Value(s) entered in the field(s) • Initials of the person(s) who validated the entry

Continued on next page

1/07 EDIT SPECIFICATIONS


EDIT SPECIFICATIONS

Cross Reference(s)

For some fields data elements will be cross-referenced with other data elements to assure accurate entries. For example: Date of Last Live Birth (27C) and/or Date of Last Other Termination (27F) may not be greater than Date of Birth (4A). A record cannot be transmitted until it passes all the cross-reference checks.

Required for Electronic Transmission to State

Indicates which data elements are to be contained on the electronic birth records sent to the State by the local registration districts.

Special Consideration(s)

Additional information for clarification of the paper certificate and electronic data elements.

1/07 EDIT SPECIFICATIONS


EDIT SPECIFICATIONS

Data Element STATE FILE NUMBER (SFN)

Definition This area is for use by the Office of Vital Records (OVR) only.

Field Name SFN (Upper left corner of certificate)

Field Length (EDP Record)

13

Record Position (EDP Record)

0001-0013

Edit Criteria Must be blank

Validation Required

None

Cross Reference(s)

None


No


This is a sample layout of what comprises a Birth State File Number.

Event Type State Century/Year Certificate Number

1 05 2007 000304

1/07 STATE FILE NUMBER (SFN)


EDIT SPECIFICATIONS

Data Element LOCAL REGISTRATION NUMBER

Definition The 13-digit number which identifies the type of event, the year in which the

event occurred, the county or LRD in which it was registered, and a sequential serial number.

Field Name LRN (Upper right corner of certificate)


13


0014-0026

Edit Criteria Numeric. May not be blank. The required format is as follows:

Entry Event Type Code Century/Year of Event LRD Code Sequential Serial Number Event Type Code (one digit): 1 = Birth Century (two digits): Valid entry is “20”. Year of Event (two digits): The last two digits of the year in which the birth occurred. LRD Code: Valid entries are all numeric, 01-58 and 61, 62, 63. Right justify, left fill with zeros. Sequential Serial Number (six digits): The sequential serial number assigned to each birth, beginning with “000001” for the first event which occurred in the calendar year. These record positions may not be blank. Right justify, left fill with zeros. Valid numeric entries are greater than all zeros (“000001” through “999998”).


1/07 LOCAL REGISTRATION NUMBER


EDIT SPECIFICATIONS

Data Element (continued)

LOCAL REGISTRATION NUMBER

Validation Required

None

Cross Reference(s)

Year of Event must equal Year of Date of Birth (4A). The Local Registration District Code (included in the Local Registration Number) must be valid for the County of Birth Occurrence (5D). This is a sample layout of the method of assigning a Local Registration Number:

Event Type Event Year LRD Code Certificate

Number 1 2007 34 000154

Certificate Number

LRD Code Year of Birth

Event Type


Yes


The electronic record and the paper certificate must reflect 13 characters (1 for the Event Type, 4 for the Event Year, 2 for the LRD, and 6 for the Certificate Number).

1/07 LOCAL REGISTRATION NUMBER


EDIT SPECIFICATIONS

Data Element NAME OF CHILD – FIRST

Definition The given name by which the child is called and distinguished from others.

Field Number 1A


30


0027-0056

Edit Criteria Name should appear exactly as shown on the certificate, including all

punctuation. Left justify with trailing blanks.

Validation Required

None

Cross Reference(s)

None


Yes


If the child has not been named, a dash, “-” must be entered on the paper certificate. However, positions on the electronic record must be blank.

1/07 NAME OF CHILD – FIRST


EDIT SPECIFICATIONS

Data Element MIDDLE (NAME OF CHILD)

Definition The name by which the child is called and distinguished from others.

Field Number 1B


24


0057-0080



Validation Required

None

Cross Reference(s)

None


Yes


If the child has not been named or has no middle name, a dash, “-” must be entered on the paper certificate. However, positions on the electronic record must be blank. “No Middle Name” (NMN), “No Middle Initial” (NMI), etc. are not acceptable entries.

1/07 MIDDLE (NAME OF CHILD)


EDIT SPECIFICATIONS

Data Element LAST (NAME OF CHILD)

Definition The family name by which the child is called and distinguished from others.

Field Number 1C


34


0081-0114


punctuation, Jr., Sr., II, III. Left justify with trailing blanks.

Validation Required

If alpha entries (other than a dash) are less than 2 characters. If the name in 1C is not contained in 6C or 9C, and if neither 1C, 6C nor 9C are equal to a dash.

Cross Reference(s)

1C, 6C and 9C may not all be blank.


Yes


If the child has not been named, a dash, “-” must be entered on the paper certificate. However, positions on the electronic record must be blank.

1/07 LAST (NAME OF CHILD)


EDIT SPECIFICATIONS

Data Element SEX

Definition The text representing the gender of the child designated as male, female or a

single dash if undetermined. The code representing the gender of the child designated as male, female or a single dash if undetermined.

Field Number 2


Text = 6 Code = 1


Text = 0115-0120 Code = 0121-0121

Edit Criteria Valid entries are:

Code Text1 = Male 2 = Female 9 = -

Validation Required

If the Sex Code is 9.

Cross Reference(s)

None


Yes


In this field the electronic representation of the sex will be a one digit numeric code. The paper certificate will show a “-” for undetermined, or “Male” or “Female” as appropriate.

1/07 SEX


EDIT SPECIFICATIONS

Data Element THIS BIRTH SINGLE, TWIN, ETC.

Definition The text representing the plurality of pregnancy, whether or not all infants or

fetuses of the conception were delivered alive. The code representing the plurality of pregnancy, whether or not all infants or fetuses of the conception were delivered alive.

Field Number 3A


Text = 12 Code = 1


Text = 0122-0133 Code = 0134-0134

Edit Criteria Valid codes are 1-8.

1 = Single 2 = Twin 3 = Triplet 4 = Quadruplet 5 = Quintuplet 6 = Sextuplet 7 = Septuplet 8 = Octuplet or more born

Validation Required

If code 4, 5, 6, 7, or 8 is entered. If this birth is single, and the Date of Last Live Birth (27C) is less than 9 months prior to Date of Birth (4A).


1/07 THIS BIRTH SINGLE, TWIN, ETC.


EDIT SPECIFICATIONS


THIS BIRTH SINGLE, TWIN, ETC.

Cross Reference (s)

Order of Birth (3B) may not be greater than the plurality unless Order of Birth (3B) is equal to 9.


Yes


In this field the electronic representation of the plurality will be a one-digit code. However, the paper certificate will have the alpha spelling of the plurality (e.g. twins, sextuplets, etc).

1/07 THIS BIRTH SINGLE, TWIN, ETC.


EDIT SPECIFICATIONS

Data Element IF MULTIPLE, THIS CHILD 1ST, 2ND, ETC.

(Also known as Order of Birth)

Definition The text representing the birth order of the child.

The code representing the birth order of the child.

Field Number 3B


1


0135-0135


Code Text Code Text1 = 1st 6 = 6th 2 = 2nd 7 = 7th 3 = 3rd 8 = 8th 4 = 4th 5 = 5th

Validation Required

If a code “1” is entered, and the Date of Last Live Birth (27C) is less than 9 months prior to the Date of Birth (4A).

Cross Reference(s)

3B may not be greater than 3A.


Yes


1/07 IF MULTIPLE, THIS CHILD 1ST, 2ND, ETC.


EDIT SPECIFICATIONS


IF MULTIPLE, THIS CHILD 1ST, 2ND, ETC. (Also known as Order of Birth)


If this is a single birth, the paper certificate will contain a dash, the electronic field will contain a “1”.

1/07 IF MULTIPLE, THIS CHILD 1ST, 2ND, ETC.


EDIT SPECIFICATIONS

Data Element DATE OF BIRTH – MONTH, DAY, YEAR

Definition The month, day, and year in which the birth occurred.

Live Birth – The complete expulsion or extraction from its mother of a product of conception (irrespective of duration of pregnancy) which, after such separation, breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached.

Field Number 4A


10


0136-0145

Edit Criteria Numeric. May not be blank. Valid entries must be in the format

CCYY-MM-DD. Dashes must be included as shown below. Example: 2007-03-04 CC = Century 20 YY = Year 00-99 MM = Month 01-12 Right justify, left fill with zeros. DD = Day 01-31 Depending on the month and allowing

for leap year.

Validation Required

If Item 3A is “single” or Item 3B is “1”, and the Date of Last Live Birth (27C) is less than 9 months prior to the Date of Birth (4A). If the Date Last Normal Menses Began (25A) precedes the Date of Birth by more than one year.


1/07 DATE OF BIRTH – MONTH, DAY, YEAR


EDIT SPECIFICATIONS


DATE OF BIRTH – MONTH, DAY, YEAR

Validation Required

If the Date of Last Live Birth (27C) and/or Date of Last Other Termination (27F) preceded the Date of Birth by more than 35 years. See Days of Gestation (GAGE) validation requirements.

Cross Reference(s)

The Date Accepted for Registration (17) may not be more than 12 months later than the Date of Birth. Date of Death (15A) may not precede Date of Birth.


Yes


In this field the electronic representation of the Date of Birth is in the format as previously stated. However, the paper certificate will be in the format of MM/DD/CCYY. Example: 06/29/2007 Month = 01-12 Slash = / Day = 01-31 Slash = / Year = Numeric (four digits of year)

1/07 DATE OF BIRTH – MONTH, DAY, YEAR


EDIT SPECIFICATIONS

Data Element HOUR – (24-HOUR CLOCK TIME) (OF BIRTH)

Definition The 24-hour clock time when this child was born. First two digits designating

hour and last two digits designating minutes. TIME CONVERSION TO 24-HOUR CLOCK Regular Clock 24-Hour Clock12:00 Midnight 0000 1:00 AM 0100 2:00 AM 0200 3:00 AM 0300 4:00 AM 0400 5:00 AM 0500 6:00 AM 0600 7:00 AM 0700 8:00 AM 0800 9:00 AM 0900 10:00 AM 1000 11:00 AM 1100 12:00 NOON 1200 1:00 PM 1300 2:00 PM 1400 3:00 PM 1500 4:00 PM 1600 5:00 PM 1700 6:00 PM 1800 7:00 PM 1900 8:00 PM 2000 9:00 PM 2100 10:00 PM 2200 11:00 PM 2300 11:59 PM 2359

Field Number 4B


4


1/07 HOUR – (24-HOUR CLOCK TIME) (OF BIRTH)


EDIT SPECIFICATIONS


HOUR – (24-HOUR CLOCK TIME) (OF BIRTH)


0146-0149

Edit Criteria Valid entries are all numeric 0000-2359 and 9999.

Hour must be 00-23, minutes 00-59. 9999 = unknown (to be used by the LRD’s only) Right justify, left fill with zeroes.

Validation Required

If Hour is 9999.

Cross Reference(s)

None


Yes


If the Hour of Birth is “Unknown”, the paper certificate will so state. However, the electronic field will show 9999.

1/07 HOUR – (24-HOUR CLOCK TIME) (OF BIRTH)


EDIT SPECIFICATIONS

Data Element PLACE OF BIRTH – NAME OF HOSPITAL OR FACILITY

Definition The name of the hospital or other place where the birth occurred. If not a

hospital, enter some descriptive noun such as “home”, “auto”, etc.

Field Number 5A


36


0150-0185

Edit Criteria Left justify with trailing blanks. Name should appear exactly as printed in

Appendix E if space allows (and if applicable).

Validation Required

None

Cross Reference(s)

The maternity hospital must be valid for the County of Birth Occurrence (5D).


Yes


Box A, Maternity Hospital Code, is derived from place of birth.

1/07 PLACE OF BIRTH – NAME OF HOSPITAL OR FACILITY


EDIT SPECIFICATIONS

Data Element STREET ADDRESS – STREET AND NUMBER, OR LOCATION (OF

PLACE OF BIRTH)

Definition The full street or rural address where the birth occurred. If enroute to a

hospital, the nearest cross streets or position on the highway, e.g. “intersection 4th and Main” or “Z miles east of Metro City on US 105”.

Field Number 5B


44


0186-0229

Edit Criteria Left justify with trailing blanks.

Validation Required

None

Cross Reference(s)

None


Yes

1/07 STREET ADDRESS…(OF PLACE OF BIRTH)


EDIT SPECIFICATIONS

Data Element CITY (OF PLACE OF BIRTH)

Definition The city (or town) where the birth occurred.

Field Number 5C


36


0230-0265


Validation Required

None

Cross Reference(s)

None


Yes

1/07 CITY (OF PLACE OF BIRTH)


EDIT SPECIFICATIONS

Data Element COUNTY (OF PLACE OF BIRTH)

Definition The text representing the name of the county where the birth occurred.

The code representing the county where the birth occurred.

Field Number 5D


Text = 16 Code = 3


Text = 0266-0281 Code = 0282-0284

Edit Criteria (Text)

Left justify with trailing blanks. See Appendix F for accepted California jurisdictions.

Edit Criteria (Code)

Right justify with leading zeros. See Appendix F for accepted values.

Validation Required

None

Cross Reference(s)

Local Registration District code (included in the Local Registration Number) must be valid for the County (of Birth Occurrence).


Yes


The text is displayed on the hardcopy.

1/07 COUNTY (OF PLACE OF BIRTH)


EDIT SPECIFICATIONS

Data Element NAME OF FATHER/PARENT – FIRST

Definition The legal first name of the father/parent.

Field Number 6A


20


0285-0304



Validation Required

None

Cross Reference(s)

If Mother Married is coded 2 or 9, and Declaration of Paternity is coded “N”, then Father’s Name (6A, 6B, 6C) must contain a dash.


Yes


If a dash, “-”, is entered on the paper birth certificate, the electronic record must also contain a dash. “Unknown”, “Withheld”, “Refused”, “Declined”, and “A.I.” (Artificial Insemination), are not acceptable entries.

1/07 NAME OF FATHER/PARENT – FIRST


EDIT SPECIFICATIONS

Data Element MIDDLE (NAME OF FATHER/PARENT)

Definition The legal middle name of the father/parent.

Field Number 6B


15


0305-0319



Validation Required

None

Cross Reference(s)

If Mother Married is coded 2 or 9, and Declaration of Paternity is coded “N”, then Father’s Name (6A, 6B, 6C) must contain a dash.


Yes


If a dash, “-”, is entered on the paper birth certificate, the electronic record must also contain a dash. “Unknown”, “Withheld”, “Refused”, “Declined”, “A.I.” (Artificial Insemination), “No Middle Name” (NMN), and “No Middle Initial” (NMI), are not acceptable entries.

1/07 MIDDLE (NAME OF FATHER/PARENT)


EDIT SPECIFICATIONS

Data Element LAST (NAME OF FATHER/PARENT)

Definition The legal last name of the male parent.

Field Number 6C


26


0320-0345

Edit Criteria Name should appear exactly as SHOWN on the certificate including all

punctuation, Jr., Sr., II, III. Other acceptable entries include a dash “-”. Ignore all AKAs (Also Known As) and all titles and degrees as follows: Ph.D., M.D., D.O., D.D.S., O.D., C.N.M., N.P., R.N., P.A., P.A.C., R.N.C., R.N.P., S.N.M., R.N.M., C.N., D.C., E.M.T., L.V.N. Left justify with trailing blanks.

Validation Required


Cross Reference(s)

1C, 6C and 9C may not all be blank. If Mother Married is coded 2 or 9, and Declaration of Paternity is coded “N”, then Father’s Name (6A, 6B, 6C) must contain a dash.


Yes


1/07 LAST (NAME OF FATHER/PARENT)


EDIT SPECIFICATIONS


LAST (NAME OF FATHER/PARENT)


If a dash, “-”, is entered on the paper birth certificate, the electronic record must also contain a dash. “Unknown”, “Withheld”, “Refused”, “Declined”, and “A.I.” (Artificial Insemination) are not acceptable entries.

1/07 LAST (NAME OF FATHER/PARENT)


EDIT SPECIFICATIONS

Data Element BIRTHPLACE – STATE/COUNTRY (OF FATHER/PARENT)

Definition The text representing the U.S. state, U.S. territory, Canadian province, or

foreign country where the father/parent was born. The code representing the U.S. state, U.S. territory, Canadian province, or foreign country where the father/parent was born. See Appendix B for birthplace codes.

Field Number 7


Text = 15 Code = 3


Text = 0346-0360 Code = 0361-0363

Edit Criteria Right justify numeric values with leading zeros.

Left justify non-numeric values with trailing blanks. Valid code entries are listed in Appendix B.

Validation Required

None

Cross Reference(s)

None


Yes


1/07 BIRTHPLACE – STATE/COUNTRY (OF FATHER/PARENT)


EDIT SPECIFICATIONS


BIRTHPLACE – STATE/COUNTRY (OF FATHER/PARENT)


If a dash, “-”, is entered on the paper certificate, the electronic record must also contain a dash. If the State of Birth is unknown, the paper certificate will have a single dash, the electronic record text will be a dash left justified with trailing blanks, and the electronic record code will be xx blank.

1/07 BIRTHPLACE – STATE/COUNTRY (OF FATHER/PARENT)


EDIT SPECIFICATIONS

Data Element DATE OF BIRTH – MONTH, DAY, YEAR (OF FATHER/PARENT)

Definition The month, day, and year of the father/parent’s birth.

Field Number 8


10


0364-0373

Edit Criteria Numeric or dashes. May not be blank. Valid entries must be in the format

CCYY-MM-DD. Dashes must be included as shown below. Example: 1976-10-24

CC = Century 19, 20 YY = Year 00-99 MM = Month 01-12 Right Justify, left fill with zeros. DD = Day 01-31 Depending on the month and allowing for

leap year.

Validation Required

See Age of Father (FAGE) validation requirements. See Father’s Education (20C) validation requirements.

Cross Reference(s)

None


Yes


1/07 DATE OF BIRTH – MONTH, DAY, YEAR (OF FATHER/PARENT)


EDIT SPECIFICATIONS


DATE OF BIRTH – MONTH, DAY, YEAR (OF FATHER/PARENT)


In this field the electronic representation of the Date of Birth is in the format as previously stated. However, the paper certificate will be in the format of MM/DD/CCYY. Example: 10/24/1976 Month = 01-12 Slash = / Day = 01-31 Slash = / Year = Numeric (four digits of year)

Incomplete Dates: If the Date of Birth is unknown, the paper certificate will have a single dash in this field. The electronic record will be all dashes. If the month is unknown, month on the paper certificate and the electronic record will be “--”. If the day is unknown, day on the paper certificate and the electronic record will be “--”.

1/07 DATE OF BIRTH – MONTH, DAY, YEAR (OF FATHER/PARENT)


EDIT SPECIFICATIONS

Data Element AGE OF FATHER/PARENT

Definition The calculated age of the father on the child’s Date of Birth (4A).

Field Name FAGE


2


0374-0375

Edit Criteria Valid codes are 01-99

99 = unknown Generate “Age of Father/Parent” by subtracting father/parent’s Date of Birth (8) from child’s Date of Birth (4A). If only the father’s year of birth is known, substitute 07 for month and 01 for day to complete the calculation. If only the father’s year and month of birth are known, substitute 15 for day to complete the calculation. If father/parent’s Date of Birth (8) is equal to dashes, assign the value “99” to “Age of Father/Parent”. If the generated “Age of Father/Parent” is not within the range of 1 through 98 inclusive, set to 99.

Validation Required

If Father’s Age (FAGE) is less than 15, or greater than 64. “Unknown” (99) is not validated. See Father’s Education (20C) validation requirements.

Cross Reference(s)

None


1/07 AGE OF FATHER/PARENT


EDIT SPECIFICATIONS


AGE OF FATHER/PARENT


Yes

1/07 AGE OF FATHER/PARENT


EDIT SPECIFICATIONS

Data Element NAME OF MOTHER/PARENT – FIRST

Definition The legal first name of the female giving birth to this child.

Field Number 9A

Field Length (EDP) Record)

20


0376-0395



Validation Required

None

Cross Reference(s)

None


Yes


If a dash, “-”, is entered on the paper certificate, the electronic record must also contain a dash. “Unknown”, “Withheld”, “Refused”, and “Declined”, are not acceptable entries.

1/07 NAME OF MOTHER/PARENT – FIRST


EDIT SPECIFICATIONS

Data Element MIDDLE (NAME OF MOTHER/PARENT)

Definition The legal middle name of the female giving birth to this child.

Field Number 9B


15


0396-0410



Validation Required

None

Cross Reference(s)

None


Yes


If a dash, “-”, is entered on the paper birth certificate, the electronic record must also contain a dash. “Unknown”, “Withheld”, “Refused”, “Declined”, “No Middle Name” (NMN), and “No Middle Initial” (NMI) are not acceptable entries.

1/07 MIDDLE (NAME OF MOTHER/PARENT)


EDIT SPECIFICATIONS

Data Element LAST – BIRTH NAME (OF MOTHER/PARENT)

Definition The legal last name (Birth Name) of the female giving birth to this child.

Field Number 9C


26


0411-0436

Edit Criteria Name should appear exactly as SHOWN on the certificate including all

punctuation, Jr., Sr., II, III. Ignore all AKAs (Also Known As) and all titles and degrees as follows: Ph.D., M.D., D.O., D.D.S., O.D., C.N.M., N.P., R.N., P.A., P.A.C., R.N.C., R.N.P., S.N.M., R.N.M., C.N., D.C., E.M.T., L.V.N. Left justify with trailing blanks.

Validation Required


Cross Reference(s)

1C, 6C and 9C may not all be blank. “Unknown” is an acceptable entry if a dash “-” is entered in 9A and 9B. (Applies to foundlings.)


Yes


1/07 LAST – BIRTH NAME (OF MOTHER/PARENT)


EDIT SPECIFICATIONS


LAST – BIRTH NAME (OF MOTHER/PARENT)


“Withheld”, “Refused”, and “Declined” are not acceptable entries.

1/07 LAST – BIRTH NAME (OF MOTHER/PARENT)


EDIT SPECIFICATIONS

Data Element BIRTHPLACE – STATE/COUNTRY (OF MOTHER/PARENT)

Definition The text representing the U.S. state, U.S. territory, Canadian province, or

foreign country where the mother/parent was born. The code representing the U.S. state, U.S. territory, Canadian province, or foreign country where the mother/parent was born. See Appendix B for birthplace codes.

Field Number 10


Text = 15 Code = 3


Text = 0437-0451 Code = 0452-0454

Edit Criteria Right justify numeric values with leading zeros.

Left justify non-numeric values with trailing blanks. Valid code entries are listed in Appendix B.

Validation Required

None

Cross Reference(s)

None


Yes


If the State of Birth is unknown, the paper certificate will have a single dash, the electronic record text will be a dash left justified with trailing blanks, and the electronic record code will be xx blank.

1/07 BIRTHPLACE – STATE/COUNTRY (OF MOTHER/PARENT)


EDIT SPECIFICATIONS

Data Element DATE OF BIRTH – MONTH, DAY, YEAR (OF MOTHER/PARENT)

Definition The month, day, and year of the mother/parent’s birth.

Field Number 11


10


0455-0464


CCYY-MM-DD. Dashes must be included as shown below. Example: 1976-10-24 CC = Century 19, 20 YY = Year 00-99 MM = Month 01-12 Right Justify, left fill with zeros. DD = Day 01-31 Depending on the month and allowing for

leap year.

Validation Required

See Age of Mother (MAGE) validation requirements. See Mother’s Education (23C) validation requirements. See Previous Live Births: Number Now Living (27A) and Now Dead (27B) validation requirements. See Other Terminations: Number Before 20 Weeks (27D) and Number After 20 Weeks (27E) validation requirements.


1/07 DATE OF BIRTH – MONTH, DAY, YEAR (OF MOTHER/PARENT)


EDIT SPECIFICATIONS


DATE OF BIRTH – MONTH, DAY, YEAR (OF MOTHER/PARENT)

Cross Reference(s)

None


Yes


In this field the electronic representation of the Date of Birth is in the format as previously stated. However, the paper certificate will be in the format of MM/DD/CCYY. For example: 12/11/1975 Month = 01-12 Slash = / Day = 01-31 Slash = / Year = Numeric (four digits)

Incomplete Dates: If the Date of Birth is unknown, the paper certificate will have a single dash in this field. The electronic record will be all dashes. If the month is unknown, month on the paper certificate and the electronic record will be “--”. If the day is unknown, day on the paper certificate and the electronic record will be “--”.

1/07 DATE OF BIRTH – MONTH, DAY, YEAR (OF MOTHER/PARENT)


EDIT SPECIFICATIONS

Data Element AGE OF MOTHER/PARENT

Definition The calculated age of the mother/parent from the child’s Date of Birth (4A).

Field Name MAGE


2


0465-0466

Edit Criteria Valid Codes are 01-99

99 = unknown Generate “Age of Mother/Parent” by subtracting mother/parent’s Date of Birth (11) from child’s Date of Birth (4A). If only the mother’s year of birth is known, substitute 07 for month and 01 for day to complete the calculation. If only the mother’s year and month of birth are known, substitute 15 for day to complete the calculation. If mother/parent’s Date of Birth (11) is equal to dashes, assign the value “99” to “Age of Mother/Parent”. If the generated “Age of Mother/Parent” is not within the range of 1 through 98 inclusive, set to 99.

Validation Required

If Mother’s Age (MAGE) is less than 15, or greater than 49. “Unknown” (99) is not validated. See Mother’s Education (23C) validation requirements. See Previous Live Births: Number Now Living (27A) and Number Now Dead (27B) validation requirements. See Other Terminations: Number Before 20 Weeks (27D) and Number After 20 Weeks (27E) validation requirements.


1/07 AGE OF MOTHER/PARENT


EDIT SPECIFICATIONS


AGE OF MOTHER/PARENT


Yes

1/07 AGE OF MOTHER/PARENT


EDIT SPECIFICATIONS

Data Element PARENT OR OTHER INFORMANT – SIGNATURE

Definition The signature of the parent verifying the correctness of the data. If neither

parent is capable of signing the certificate, a person with knowledge of the facts may sign attesting to the correctness of the data. A signature made with a mark (X) must be identified with the statement “Her mark” or “His mark”, followed by the written signature of one person who witnessed the signing, and the word “witness”.

Field Number 12A


39


0467-0505


Validation Required

None

Cross Reference(s)

None


Yes


When the informant signs with an “X”, enter the name of the informant into the electronic file. Do not enter “X” – Her/His mark” or the name of the witness and the term “witness” in the electronic file. The informant may be identified by “Relationship to Child” (12B).

1/07 PARENT OR OTHER INFORMANT – SIGNATURE


EDIT SPECIFICATIONS

Data Element RELATIONSHIP TO CHILD (OF PARENT OR OTHER INFORMANT)

Definition The relationship to the child of the person certifying the correctness of the

information, e.g. Mother, Father, Grandmother, Medical Records Clerk, etc. NOTE: “Parents” may only be entered when both parents sign in 12A.

Field Number 12B


Text = 16 Code = 1


Text = 0506-0521 Code = 0522-0522


Valid entries are:

Code Text

0 = Parent 1 = Mother 2 = Father or Parents 3 = Grandparent or Grandmother or Grandfather 4 = Other Relative or Aunt or Uncle or Niece or Nephew or Sister

or Brother or Guardian 5 = Friend or Neighbor 6 = Certified Midwife or Midwife 7 = Medical Record Clerk, Birth Recorder, or Other Hospital

Employee or Other Medical Staff 8 = Other or Ambulance Attendant or Social Worker or any word

stated that is not listed above 9 = unknown

Validation Required

None


1/07 RELATIONSHIP TO CHILD (OF PARENT OR OTHER INFORMANT)


EDIT SPECIFICATIONS


RELATIONSHIP TO CHILD (OF PARENT OR OTHER INFORMANT)

Cross Reference(s)

The code should correspond to the text.


Yes


“None” is not an acceptable entry.

1/07 RELATIONSHIP TO CHILD (OF PARENT OR OTHER INFORMANT)


EDIT SPECIFICATIONS

Data Element DATE SIGNED (BY PARENT OR OTHER INFORMANT)

Definition The month, day and year the completed certificate was reviewed and signed

by the informant (12A).

Field Number 12C


10


0523-0532

Edit Criteria Numeric. May not be blank. Valid entries must be in the format CCYY-

MM-DD. Dashes must be included as shown below. Example 2007-02-20

CC = Century 20 YY = Year 00-99 MM = Month 01-12 Right justify, left fill with zeros. DD = Day 01-31 Depending on the month and allowing

for leap year.

Validation Required

None

Cross Reference(s)

Date Signed may not precede Date of Birth (4A). Date signed may not be greater than the current date.


Yes


1/07 DATE SIGNED (BY PARENT OR OTHER INFORMANT)


EDIT SPECIFICATIONS


DATE SIGNED (BY PARENT OR OTHER INFORMANT)


In this field the electronic representation of the Date Signed is in the format as previously stated. However, the paper certificate will be in the format of MM/DD/CCYY. Example: 02/20/2007 Month = 01-12 Slash = / Day = 01-31 Slash = / Year = Numeric (four digits of year)

If date is entered by hand at same time as Signature (12A), any date configuration is acceptable.

1/07 DATE SIGNED (BY PARENT OR OTHER INFORMANT)


EDIT SPECIFICATIONS

Data Element LICENSE NUMBER (OF ATTENDANT)

Definition The California Physician’s license number, or Certified Nurse Midwife’s

license number of the individual who attended the birth.

Field Number 13B


13


0533-0545


Validation Required

None

Cross Reference(s)

None


Yes


If a dash, “-”, is entered on the paper certificate, the electronic record must also contain a dash.

1/07 LICENSE NUMBER (OF ATTENDANT)


EDIT SPECIFICATIONS

Data Element DATE SIGNED (BY ATTENDANT OR CERTIFIER)

Definition The month, day and year the attendant or certifier, whose signature appears in

13A, reviewed the completed certificate and certified the correctness of the data.

Field Number 13C


10


0546-0555

Edit Criteria Numeric or dash. May not be blank. Valid entries must be in the format

CCYY-MM-DD. Dashes must be included as shown below. Example: 2007-02-22 CC = Century 20 YY = Year 00-99 MM = Month 01-12 Right justify, left fill with zeros. DD = Day 01-31 Depending on the month and allowing

for leap year.

Validation Required

None

Cross Reference(s)

Date signed may not precede Date of Birth (4A). Date signed may not be greater than current date.


1/07 DATE SIGNED (BY ATTENDANT OR CERTIFIER)


EDIT SPECIFICATIONS


DATE SIGNED (BY ATTENDANT OR CERTIFIER)


Yes


In this field the electronic representation of the Date Signed is in the format as previously stated. However, the paper certificate will be in the format of MM/DD/CCYY. Example: 02/22/2007 Month = 01-12 Slash = / Day = 01-31 Slash = / Year = Numeric (four digits of year)


1/07 DATE SIGNED (BY ATTENDANT OR CERTIFIER)


EDIT SPECIFICATIONS

Data Element TYPED NAME, TITLE AND MAILING ADDRESS OF ATTENDANT

Definition Self-explanatory.

Field Number 13D


60


0556-0615


Validation Required

None

Cross Reference(s)

None


Yes


The code for attendant is in Box D. See Appendix G for valid attendant codes. If a dash, “-”, is entered on the paper certificate, the electronic record must also contain a dash.

1/07 TYPED NAME, TITLE AND MAILING ADDRESS OF ATTENDANT


EDIT SPECIFICATIONS

Data Element TYPED NAME AND TITLE OF CERTIFIER IF OTHER THAN

ATTENDANT

Definition Self-explanatory.

Field Number 14


29


0616-0644


If certifier is also the attendant, place a single dash in this field.

Validation Required

None

Cross Reference(s)

None


Yes



1/07 TYPED NAME AND TITLE OF CERTIFIER IF OTHER THAN ATTENDANT


EDIT SPECIFICATIONS

Data Element DATE OF DEATH

Definition The month, day and year the person for whom the birth certificate is being

prepared died.

Field Number 15A


10


0645-0654

Edit Criteria Numeric or all blank. Valid entries must be in the format CCYY-MM-DD.

Dashes must be included as shown below. Example: 2007-02-22


for leap year.

Validation Required

If the Birthweight (26) is less than 1000 grams and no Date of Death is entered.


1/07 DATE OF DEATH


EDIT SPECIFICATIONS


DATE OF DEATH

Cross Reference(s)

Date of Death may not precede Date of Birth (4A). Date of Death may not be greater than current date.

Required for Electronic Transmission to Sate

Yes


In this field the electronic representative of the Date of Death is in the format as previously stated. However, the paper certificate will be in the format of MM/DD/CCYY. Example: 02/22/2006 Month = 01-12 Slash = / Day = 01-31 Slash = / Year = Numeric (four digits of year)

1/07 DATE OF DEATH


EDIT SPECIFICATIONS

Data Element STATE FILE NUMBER (OF DEATH CERTIFICATE)

Definition This area is for use by Office of Vital Records (OVR) only. It records the

child’s death certificate State File Number.

Field Number 15B


13


0655-0667

Edit Criteria Must be blank

Validation Required

None

Cross Reference(s)

None


No


This is a sample layout of what comprises a Death State File Number.

Event Type State Century/Year Certificate Number

3 05 2007 000304

1/07 STATE FILE NUMBER (OF DEATH CERTIFICATE)


EDIT SPECIFICATIONS

Data Element DEATH INDICATOR

Definition An indicator flag showing if this person has died.

Field Name DI


1


0668-0668

Edit Criteria Valid Codes are 0-3

0 = No death has been recorded 1 = Neonatal Death 2 = Post Neonatal Death 3 = Other Death Generate values for Death Indicator as follows: If a child’s Date of Death (15A) is not present, set the value of Death Indicator to zero. If it is present, calculate the number of days old that the child was at Date of Death (i.e., child Date of Death (15A) minus child Date of Birth (4A)). If the number of days old at death is between “0” and “27” inclusive, set the value of Death Indicator to “1” (Neonatal Death). If it is greater than “27” but less than “365” (28 days-364 days), set the Death Indicator code to “2” (Post Neonatal Death). If days old at death is greater than 364 days, set the Death Indicator code to “3” (Other Death).

Validation Required

None

Cross Reference(s)

None


1/07 DEATH INDICATOR


EDIT SPECIFICATIONS


DEATH INDICATOR


Yes

1/07 DEATH INDICATOR


EDIT SPECIFICATIONS

Data Element LOCAL REGISTRAR – SIGNATURE

Definition The signature (authentic or facsimile) of the local registrar accepting the birth

certificate.

Field Number 16


38


0669-0706


Validation Required

None

Cross Reference(s)

None


Yes

1/07 LOCAL REGISTRAR – SIGNATURE


EDIT SPECIFICATIONS

Data Element DATE ACCEPTED FOR REGISTRATION

Definition The month, day and year in which the local registrar accepted the certificate.

Field Number 17


10


0707-0716

Edit Criteria Numeric. May not be blank. Valid entries must be in the format



for leap year.

Validation Required

None


1/07 DATE ACCEPTED FOR REGISTRATION


EDIT SPECIFICATIONS


DATE ACCEPTED FOR REGISTRATION

Cross Reference(s)

The Date Accepted for Registration may not be more than 12 months later than the Date of Birth (4A). (This cross-reference is used at the LRD). The Date Accepted for Registration may not precede the Date of Birth (4A). The Date Accepted for Registration may not be greater than current date. The Date Accepted for Registration may not precede Date Signed by Parent or Other Informant (12C). The Date Accepted for Registration may not precede Date Signed by Attendant or Certifier (13C).


Yes


In this field, the electronic representation of the Date Accepted for Registration is in the format as previously stated. However, the paper certificate will be in the format of MM/DD/CCYY. Example: 02/22/2007 Month = 01-12 Slash = / Day = 01-31 Slash = / Year = Numeric (four digits of year)

1/07 DATE ACCEPTED FOR REGISTRATION


EDIT SPECIFICATIONS

Data Element RACE (OF FATHER)

Definition The text representing the race(s) of the father selected by the informant from

the VS 10B, Race/Ethnicity and Education Worksheet in Appendix C. The code(s) representing the race(s) of the father selected by the informant from the Race/Ethnicity and Education Worksheet in Appendix C.

Field Number 18

Field Length Text with delimiters = 50 (3 x 16+2)

Text without delimiters = 48 (3 x 16) Codes = 6 (3 x 2)

Record Position Text with delimiters = 0717-0766

Text without delimiters = 0767-0814 Codes = 0815-0820

Edit Criteria See “Special Consideration(s)”.

Validation Required

None

Cross Reference(s)

None


Yes


1/07 RACE (OF FATHER)


EDIT SPECIFICATIONS


RACE (OF FATHER)


The text for up to three race choices from Appendix C will appear on the paper certificate, with up to three races of up to 17 characters each separated by a delimiter (/). If three races plus two delimiters exceed 50 characters, it will be necessary to truncate the printed races starting with the last character of the third race, then the last character of the second race, then the last character of the first race, then the next-to-last character of the third race, then the next-to-last character of the third race, etc. Both the text and the corresponding codes from Appendix C will appear on the electronic record. The text as printed on the certificate will appear (left justified with trailing blanks) in record positions 0717-0766. Each individual race text, without delimiters, will appear (left justified with trailing blanks) in record positions 0767-0782, 0783-0798, 0799-0814 and their corresponding codes will appear in record positions 0815-0816, 0817-0818, 0819-0820. “Unknown” and “Withheld” are acceptable entries if only one race is reported on the paper certificate. If “Unknown” or “Withheld” are entered as the first race, the second and third races should not be reported.

1/07 RACE (OF FATHER)


EDIT SPECIFICATIONS

Data Element FATHER HISPANIC, LATINO, OR SPANISH?

Definition The text representing the Hispanic origin or descent of father selected by the

informant from the VS 10B, Race/Ethnicity and Education Worksheet in Appendix C. The code representing the Hispanic origin or descent of father selected by the informant from the Race/Ethnicity and Education Worksheet in Appendix C.

Field Number 19


Text = 18 Code = 1


Text = 0821-0838 Code = 0839-0839

Edit Criteria Valid codes are 1-6, 8 or 9. Refer to Appendix C for explanation of codes.

Validation Required

None

Cross Reference(s)

None


Yes


If “Unknown” or “Withheld” is entered on the paper certificate, the code should be “9”.

1/07 FATHER HISPANIC, LATINO, OR SPANISH?


EDIT SPECIFICATIONS

Data Element DATE LAST WORKED (OF FATHER)

Definition The father’s most recent date of employment.

Field Number 20


10

Record Position 0840-0849


CCYY-MM---. Dashes must be included as shown below. Example: 2007-07--- CC = Century 19, 20 YY = Year 00-99 MM = Month 01-12 Right justify, left fill with zeros.

See “Special Consideration(s)” for the electronic representation of the date when “None”, “Withheld”, “Unknown” or incomplete dates are entered on the paper certificate.

Validation Required

None

Cross Reference(s)

The Date Last Worked (20) may not precede the father’s Date of Birth (8). The Date Last Worked (20) may not be greater than the child’s Date of Birth (4A).


Yes


1/07 DATE LAST WORKED (OF FATHER)


EDIT SPECIFICATIONS


DATE LAST WORKED (OF FATHER)


In this field, the electronic representation of the Date Last Worked (20) is in the format as previously stated. However, the paper certificate will be in the format MM/CCYY. Example: 07/2007 Month = 01-12 Slash = / Year = Numeric (four digits of year)

None, withheld, unknown or incomplete dates: If “None” is entered on the paper certificate, the electronic record will be “0000-00-00”. If “Withheld” is entered on the paper certificate, the electronic record will be “9999-99-99”. If “Unknown” is entered on the paper certificate, the electronic record will be all dashes. If the month is unknown, month on the paper certificate and on the electronic record will be “--”.

1/07 DATE LAST WORKED (OF FATHER)


EDIT SPECIFICATIONS

Data Element USUAL OCCUPATION (OF FATHER)

Definition The occupation in which the father has been employed most of the time. If

father is retired, unemployed, or disabled, report usual occupation when he was working.

Field Number 20A


39


0850-0888


Validation Required

None

Cross Reference(s)

None


Yes


“Unknown” or “Withheld” may be entered on the paper certificate.

1/07 USUAL OCCUPATION (OF FATHER)


EDIT SPECIFICATIONS

Data Element KIND OF BUSINESS OR INDUSTRY (OF FATHER)

Definition The term that indicates clearly and specifically the kind of business or

industry of the employing firm. More specifically, what term indicates the major activity at the father’s usual place of work.

Field Number 20B


36


0889-0924


Validation Required

None

Cross Reference(s)

None


Yes



1/07 KIND OF BUSINESS OR INDUSTRY (OF FATHER)


EDIT SPECIFICATIONS

Data Element EDUCATION – HIGHEST LEVEL/DEGREE (OF FATHER)

Definition The highest degree or number of years of schooling completed by the father.

Do not include beauty, barber, trade, business, technical or other special schools.

Field Number 20C


16


0925-0940


Valid entries are:

00 = No formal education 01-11 = Grades 1-11 12 ND = Grade 12, no diploma HS GRADUATE = High school graduate GED = Passed General Educational Development exam SOME COLLEGE = Some college ASSOCIATE = Associate degree BACHELOR’S = Bachelor’s degree MASTER’S = Master’s degree DOCTORATE = Doctorate degree PROFESSIONAL = Professional degree WITHHELD = Withheld UNKNOWN = Unknown


1/07 EDUCATION – HIGHEST LEVEL/DEGREE (OF FATHER)


EDIT SPECIFICATIONS


EDUCATION – HIGHEST LEVEL/DEGREE (OF FATHER)

Validation Required

If grades 1-12 ND, and Father’s Age (FAGE) is not at least 4 years greater than father’s years of education. If HS GRADUATE or GED, and Father’s Age (FAGE) is less than 16 years. If SOME COLLEGE, and Father’s Age (FAGE) is less than 17 years. If ASSOCIATE, and Father’s Age (FAGE) is less than 18 years. If BACHELOR’S, and Father’s Age (FAGE) is less than 20 years. If MASTER’S, and Father’s Age (FAGE) is less than 21 years. If DOCTORATE or PROFESSIONAL, and Father’s Age (FAGE) is less than 23 years.

Cross Reference(s)

None


Yes


If the father had no formal education, or only completed grades 1-9, the electronic record will contain one leading zero, the value, and trailing blanks. However, a leading zero will not be printed on the paper certificate.

1/07 EDUCATION – HIGHEST LEVEL/DEGREE (OF FATHER)


EDIT SPECIFICATIONS

Data Element RACE (OF MOTHER)

Definition The text representing the race(s) of the mother selected by the informant from

the VS 10B, Race/Ethnicity and Education Worksheet in Appendix C. The codes representing the race(s) of the mother selected by the informant from the Race/Ethnicity and Education Worksheet in Appendix C.

Field Number 21

Field Length Text with delimiters = 50 (3 x 16+2)

Text without delimiters = 48 (3 x 16) Codes = 6 (3 x 2)

Record Position Text with delimiters = 0941-0990

Text without delimiters = 0991-1038 Codes = 1039-1044

Edit Criteria See “Special Consideration(s)”.

Validation Required

None

Cross Reference(s)

None


Yes


1/07 RACE (OF MOTHER)


EDIT SPECIFICATIONS


RACE (OF MOTHER)


The text for up to three race choices from Appendix C will appear on the paper certificate, with up to three races of up to 17 characters each separated by a delimiter (/). If three races plus two delimiters exceed 50 characters, it will be necessary to truncate the printed races starting with the last character of the third race, then the last character of the second race, then the last character of the first race, then the next-to-last character of the third race, etc. Both the text and the corresponding codes from Appendix C will appear on the electronic record. The text as printed on the certificate will appear (left justified with trailing blanks) in record positions 0941-0990. Each individual race text, without delimiters, will appear (left justified with trailing blanks) in record positions 0991-1006, 1007-1022, 1023-1038 and their corresponding codes will appear in record positions 1039-1040, 1041-1042, 1043-1044. “Unknown” and “Withheld” are acceptable entries if only one race is reported on the paper certificate. If “Unknown” or “Withheld” are entered as the first race, the second and third races should not be reported.

1/07 RACE (OF MOTHER)


EDIT SPECIFICATIONS

Data Element MOTHER HISPANIC, LATINA, OR SPANISH?

Definition The text representing the Hispanic origin or descent of mother selected by the

informant from the VS 10B, Race/Ethnicity and Education in Appendix C. The code representing the Hispanic origin or descent of mother selected by the informant from the Race/Ethnicity and Education in Appendix C.

Field Number 22


Text = 18 Code = 1


Text = 1045-1062 Code = 1063-1063

Edit Criteria Valid codes are 1-6, 8 or 9. Refer to Appendix C for explanation of codes.

Validation Required

None

Cross Reference(s)

None


Yes


If “Unknown” or “Withheld” is entered on the paper certificate, the code should be “9”.

1/07 MOTHER HISPANIC, LATINA, OR SPANISH?


EDIT SPECIFICATIONS

Data Element DATE LAST WORKED (OF MOTHER)

Definition The mother’s most recent date of employment.

Field Number 23


10

Record Position 1064-1073


CCYY-MM---. Dashes must be included as shown below. Example: 2007-07--- CC = Century 19, 20 YY = Year 00-99 MM = Month 01-12 Right justify, left fill with zeros.

See “Special Consideration(s)” for the electronic representation of the date when “None”, “Withheld”, “Unknown” or incomplete dates are entered on the paper certificate.

Validation Required

None

Cross Reference(s)

The Date Last Worked (23) may not precede the mother’s Date of Birth (11). The Date Last Worked (23) may not be greater than the child’s Date of Birth (4A).


Yes


1/07 DATE LAST WORKED (OF MOTHER)


EDIT SPECIFICATIONS


DATE LAST WORKED (OF MOTHER)


In this field, the electronic representation of the Date Last Worked (23) is in the format as previously stated. However, the paper certificate will be in the format MM/CCYY. Example: 07/2007 Month = 01-12 Slash = / Year = Numeric (four digits of year)

None, withheld, unknown or incomplete dates: If “None” is entered on the paper certificate, the electronic record will be “0000-00-00”. If “Withheld” is entered on the paper certificate, the electronic record will be “9999-99-99”. If “Unknown” is entered on the paper certificate, the electronic record will be all dashes. If the month is unknown, the month on the paper certificate and on the electronic record will be “--”.

1/07 DATE LAST WORKED (OF MOTHER)


EDIT SPECIFICATIONS

Data Element USUAL OCCUPATION (OF MOTHER)

Definition The occupation in which the mother has been employed most of the time. If

mother is retired, unemployed, or disabled, report usual occupation when she was working.

Field Number 23A


39


1074-1112


Validation Required

None

Cross Reference(s)

None


Yes



1/07 USUAL OCCUPATION (OF MOTHER)


EDIT SPECIFICATIONS

Data Element KIND OF BUSINESS OR INDUSTRY (OF MOTHER)

Definition The term that indicates clearly and specifically the kind of business or

industry of the employing firm. More specifically, what term indicates the major activity at the mother’s usual place of work.

Field Number 23B


36


1113-1148


Validation Required

None

Cross Reference(s)

None


Yes



1/07 KIND OF BUSINESS OR INDUSTRY (OF MOTHER)


EDIT SPECIFICATIONS

Data Element EDUCATION – HIGHEST LEVEL/DEGREE (OF MOTHER)

Definition The highest degree or number of years of schooling completed by the mother.

Do not include beauty, barber, trade, business, technical or other special schools.

Field Number 23C


16


1149-1164


Valid entries are:

00 = No formal education 01-11 = Grades 1-11 12 ND = Grade 12, no diploma HS GRADUATE = High school graduate GED = Passed General Educational Development exam SOME COLLEGE = Some college ASSOCIATE = Associate degree BACHELOR’S = Bachelor’s degree MASTER’S = Master’s degree DOCTORATE = Doctorate degree PROFESSIONAL = Professional degree WITHHELD = Withheld UNKNOWN = Unknown


1/07 EDUCATION – HIGHEST LEVEL/DEGREE (OF MOTHER)


EDIT SPECIFICATIONS


EDUCATION – HIGHEST LEVEL/DEGREE (OF MOTHER)

Validation Required

If grades 1-12 ND, and Mother’s Age (MAGE) is not at least 4 years greater than mother’s years of education. If HS GRADUATE or GED, and Mother’s Age (MAGE) is less than 16 years. If SOME COLLEGE, and Mother’s Age (MAGE) is less than 17 years. If ASSOCIATE, and Mother’s Age (MAGE) is less than 18 years. If BACHELOR’S, and Mother’s Age (MAGE) is less than 20 years. If MASTER’S, and Mother’s Age (MAGE) is less than 21 years. If DOCTORATE or PROFESSIONAL, and Mother’s Age (MAGE) is less than 23 years.

Cross Reference(s)

None


Yes


If the mother had no formal education, or only completed grades 1-9, the electronic record will contain one leading zero, the value, and trailing blanks. However, a leading zero will not be printed on the paper certificate.

1/07 EDUCATION – HIGHEST LEVEL/DEGREE (OF MOTHER)


EDIT SPECIFICATIONS

Data Element MOTHER’S RESIDENCE – STREET AND NUMBER, OR LOCATION

Definition The usual residence address for the mother of this child.

Field Number 24A


50


1165-1214


Validation Required

None

Cross Reference(s)

None


Yes

1/07 MOTHER’S RESIDENCE – STREET, NUMBER, OR LOCATION


EDIT SPECIFICATIONS

Data Element COUNTY/PROVINCE (OF RESIDENCE OF MOTHER)

Definition The U.S. county or Canadian province where the mother usually resides.

Field Number 24B


30


1215-1244


See Appendix F for accepted California county entries and Special Consideration(s) for accepted Canadian province entries.

Validation Required

None

Cross References(s)

None


Yes


Mother’s County/Province of Residence is used for coding Place of Mother’s Residence, see Box B specifications.


1/07 COUNTY/PROVINCE (OF RESIDENCE OF MOTHER)


EDIT SPECIFICATIONS


COUNTY/PROVINCE (OF RESIDENCE OF MOTHER)


The Canadian provinces include: ALBERTA BRITISH COLUMBIA MANITOBA NEW BRUNSWICK NEWFOUNDLAND NORTHWEST TERRITORIES NOVA SCOTIA NUNAVUT ONTARIO PRINCE EDWARD ISLAND QUEBEC SASKATCHEWAN YUKON TERRITORY

1/07 COUNTY/PROVINCE (OF RESIDENCE OF MOTHER)


EDIT SPECIFICATIONS

Data Element CITY (OF RESIDENCE OF MOTHER)

Definition The city (or town) in which the mother usually resides.

Field Number 24C


35


1245-1279


Validation Required

None

Cross Reference(s)

None


Yes

1/07 CITY (OF RESIDENCE OF MOTHER)


EDIT SPECIFICATIONS

Data Element STATE/FOREIGN COUNTRY (OF RESIDENCE OF MOTHER)

Definition The U.S. state, U.S. territory, or foreign country where the mother usually

resides.

Field Number 24D


25


1280-1304


See Appendix B for abbreviations that may be used.

Validation Required

None

Cross Reference(s)

If the code in State/Foreign Country of Residence of Mother is not a U.S. state, American Samoa, Guam, Puerto Rico, or Virgin Islands, set ZIP Code of Residence of Mother (24E) to zeros.


Yes


Mother’s State/Foreign Country of Residence can be used for coding Place of Mother’s Residence, see Box B specifications.

1/07 STATE/FOREIGN COUNTRY (OF RESIDENCE OF MOTHER)


EDIT SPECIFICATIONS

Data Element ZIP CODE (OF RESIDENCE OF MOTHER)

Definition The zip code of the mother’s usual residence address if in the U. S. A.

Field Number 24E


5


1305-1309

Edit Criteria Valid entries are all blank or all numeric.

Five characters = Zip Code

Validation Required

None

Cross Reference(s)

If the code in State/Foreign Country of Residence of Mother (24D) is not a U.S. state, American Samoa, Guam, Puerto Rico, or Virgin Islands, set ZIP Code of Residence of Mother to zeros.


Yes


1/07 ZIP CODE (OF RESIDENCE OF MOTHER)


EDIT SPECIFICATIONS


ZIP CODE (OF RESIDENCE OF MOTHER)


If Item 24D is within the USA or a US territory and a zip code is present, the electronic representation of the zip code will be five digits. However, if the paper certificate indicates unknown, this field will be blank on the electronic record.

1/07 ZIP CODE (OF RESIDENCE OF MOTHER)


EDIT SPECIFICATIONS

Data Element DATE LAST NORMAL MENSES BEGAN – MONTH, DAY, YEAR

Definition The date the last normal menses (menstrual period) began. (month, day and

year).

Field Number 25A


10


1310-1319

Edit Criteria Numeric or dashes. May not be blank. EDP record format:


CC = Century 20 YY = Year 00-99 MM = Month 01-12 Right justify, left fill with zeros. DD = Day 01-31 Depending on the month and allowing for

leap year.

Validation Required

If the Date of Last Menses precedes the Date of Birth (4A) by more than one year, the information must be validated. See Days of Gestation (GAGE) validation requirements.

Cross Reference(s)

Date Last Normal Menses Began must be less than Date of Birth (4A).


1/07 DATE LAST NORMAL MENSES BEGAN – MONTH, DAY, YEAR


EDIT SPECIFICATIONS


DATE LAST NORMAL MENSES BEGAN – MONTH, DAY, YEAR


Yes


If the Date Last Normal Menses Began is unknown, the paper certificate will state “Unknown” in this field. The electronic record will be all dashes. If the month is unknown, month on the paper certificate and on the electronic record will be “--”. If the day is unknown, day on the paper certificate and on the electronic record will be “--”. In this field the electronic representation of the Date of Last Normal Menses Began is in the format as previously stated. However, the paper certificate will be in the format of MM/DD/CCYY. Example: 06/20/2006

Month = 01-12 Slash = / Day = 01-31 Slash = / Year = Numeric (four digits of year)

1/07 DATE LAST NORMAL MENSES BEGAN – MONTH, DAY, YEAR


EDIT SPECIFICATIONS

Data Element DATE FIRST PRENATAL CARE VISIT

Definition The date that the mother had her first prenatal care visit for this pregnancy.

Field Number 25AA


10


1320-1329


CCYY-MM-DD. Dashes must be included as shown under “Special Consideration(s)”. Example: 2007-06-12 CC = Century 20 YY = Year 00-99 MM = Month 01-12 Right justify, left fill with zeros. DD = Day 01-31 Depending on the month and allowing

for leap year.

Validation Required

If Date First Prenatal Care Visit (25AA) is more than 10 months before the Date of Birth (4A).

Cross Reference(s)

Date First Prenatal Care Visit (25AA) must be earlier than Date of Birth (4A). If there is a date for both the first and last prenatal care visit, Date First Prenatal Care Visit (25AA) must be earlier or the same as Date Last Prenatal Care Visit (25BA).


1/07 DATE FIRST PRENATAL CARE VISIT


EDIT SPECIFICATIONS


DATE FIRST PRENATAL CARE VISIT

Cross Reference(s) (continued)

If Date First Prenatal Care Visit (25AA) contains “0000-00-00”, Date Last Prenatal Care Visit (25BA) must contain “0000-00-00”, and Month Prenatal Care Began (25B), Number of Prenatal Care Visits (25C), Principal Source of Payment for Prenatal Care (25D) must contain “00”. If Date First Prenatal Care Visit (25AA) contains a date or all dashes, Date Last Prenatal Care Visit (25BA) must contain a date or all dashes, and Month Prenatal Care Began (25B), Number of Prenatal Care Visits (25C), Principal Source of Payment for Prenatal Care (25D) must contain a value other than “00”.


Yes


In this field the electronic representation of the Date First Prenatal Care Visit is in the format as previously stated. However, the paper certificate will be in the format of MM/DD/CCYY. Example: 06/12/2006 Month = 01-12 Slash = / Day = 01-31 Slash = / Year = Numeric (four digits of year)

No visits, unknown or incomplete dates: If there were no prenatal care visits, the paper certificate will have “NONE” in this field and the electronic record will be “0000-00-00”. If the Date First Prenatal Care Visit is unknown, the paper certificate will state “Unknown” in this field and the electronic record will be all dashes. If the month is unknown, month on the paper certificate and the electronic record will be “--”. If the day is unknown, day on the paper certificate and the electronic record will be “--”.

1/07 DATE FIRST PRENATAL CARE VISIT


EDIT SPECIFICATIONS

Data Element MONTH PRENATAL CARE BEGAN

Definition The month of pregnancy in which the mother had her first prenatal care visit

for this pregnancy.

Field Number 25B


Text = 3 Code = 2


Text = 1330-1332 Code = 1333-1334


Code Text00 = 0 01 = 1st

02 = 2nd

03 = 3rd

04 = 4th

05 = 5th

06 = 6th

07 = 7th

08 = 8th

09 = 9th

99 = Unknown Text is left justified with trailing blanks. Valid codes are 00-99 and 99. Codes: 00 = No prenatal care

01-09 = The first through the ninth month of pregnancy,

respectively. 99 = Unknown or not stated.


1/07 MONTH PRENATAL CARE BEGAN


EDIT SPECIFICATIONS


MONTH PRENATAL CARE BEGAN

Validation Required

None

Cross Reference(s)

If Month Prenatal Care Began (25B) is equal to “00”, Date First Prenatal Care Visit (25AA) and Date Last Prenatal Care Visit (25BA) must contain “0000-00-00”, the Number of Prenatal Care Visits (25C) and Principal Source of Payment for Prenatal Care (25D) must equal “00”. If Month Prenatal Care Began (25B) contains a value other than “00”, Date First Prenatal Care Visit (25AA) and Date Last Prenatal Care Visit (25BA) must contain a date or all dashes, the Number of Prenatal Care Visits (25C) and Principal Source of Payment for Prenatal Care (25D) must contain a value other than “00”.


Yes


If the Month Prenatal Care Began is unknown or not stated, the paper certificate will reflect “Unknown”, the electronic record text must contain “Unk”, and the electronic code must contain “99”.

1/07 MONTH PRENATAL CARE BEGAN


EDIT SPECIFICATIONS

Data Element DATE LAST PRENATAL CARE VISIT

Definition The date that the mother had her last prenatal care visit for this pregnancy.

Field Number 25BA

Field Length (EDP) Record)

10


1335-1344


CCYY-MM-DD. Dashes must be included as shown under “Special Consideration(s)”. Example: 2007-06-29 CC = Century 20 YY = Year 00-99 MM = Month 01-12 Right justify, left fill with zeros. DD = Day 01-31 Depending on the month and

allowing for leap year.

Validation Required

None

Cross Reference(s)

Date Last Prenatal Care Visit (25BA) can be no later than Date of Birth (4A). If there is a date for both the first and last prenatal care visit, Date First Prenatal Care Visit (25AA) must be earlier or the same as Date Last Prenatal Care Visit (25BA).


1/07 DATE LAST PRENATAL CARE VISIT


EDIT SPECIFICATIONS


DATE LAST PRENATAL CARE VISIT


If Date Last Prenatal Care Visit (25BA) contains “0000-00-00”, Date First Prenatal Care Visit (25AA) must contain “0000-00-00”, and Month Prenatal Care Began (25B), Number of Prenatal Care Visits (25C), Principal Source of Payment for Prenatal Care (25D) must contain a value other than “00”. If Date Last Prenatal Care Visit (25BA) contains a date or all dashes, Date First Prenatal Care Visit (25AA) must contain a date or all dashes, and Month Prenatal Care Began (25B), Number of Prenatal Visits (25C), Principal Source of Payment for Prenatal Care (25D) must contain a value other than “00”.


Yes


In this field the electronic representation of the Date Last Prenatal Care Visit is in the format as previously stated. However, the paper certificate will be in the format of MM/DD/CCYY. Example: 06/12/2006 Month = 01-12 Slash = / Day = 01-31 Slash = / Year = Numeric (four digits of year)

No visits, unknown or incomplete dates: If there were no prenatal care visits, the paper certificate will state “None” in this field. The electronic record will be “0000-00-00”. If the Date Last Prenatal Care Visit is unknown, the paper certificate will state “Unknown” in this field. The electronic record will be all dashes.




EDIT SPECIFICATIONS


DATE LAST PRENATAL CARE VISIT

Special Consideration(s) (continued)

If the month is unknown, month on the paper certificate and the electronic record will be “--”. If the day is unknown, day on the paper certificate and the electronic record will be “--”.



EDIT SPECIFICATIONS

Data Element NUMBER OF PRENATAL VISITS

Definition A prenatal visit is defined as medical/obstetrical care during pregnancy which

is provided to the woman by a physician, certified nurse midwife, nurse practitioner, or physician’s assistant. Do not count the initial visit for confirmation of the pregnancy as a prenatal visit. Do not include emergency room visits or other medical visits which are solely or primarily for non pregnancy-related problems, e.g., accidents, etc. Do not count visits to a nutritionist, dietitian, health educator, or other health care professional not listed above.

Field Number 25C


2


1345-1346


99 = Unknown Right justify, left fill with zeros.

Validation Required

Yes, if 50-98 are entered.

Cross Reference(s)

If Number of Prenatal Care Visits (25C) is equal to “00”, Date First Prenatal Care Visit (25AA) and Date Last Prenatal Care Visit (25BA) must contain “0000-00-00”, the Month Prenatal Care Began (25B) and Principal Source of Payment for Prenatal Care (25D) must equal “00”.


1/07 NUMBER OF PRENATAL VISITS


EDIT SPECIFICATIONS


NUMBER OF PRENATAL VISITS


If Number of Prenatal Care Visits (25C) contains a value other than “00”, Date First Prenatal Care Visit (25AA) and Date Last Prenatal Care Visit (25BA) must contain a date or all dashes, the Month Prenatal Care Began (25B) and Principal Source of Payment for Prenatal Care (25D) must contain a value other than “00”.


Yes


If the number of prenatal visits is unknown, “Unknown” will be entered on the paper certificate, and the electronic file will be coded “99”.

1/07 NUMBER OF PRENATAL VISITS


EDIT SPECIFICATIONS

Data Element PRINCIPAL SOURCE OF PAYMENT FOR PRENATAL CARE

Definition The code representing the principal source of payment as defined in

Appendix A.

Field Number 25D


2


1347-1348

Edit Criteria Valid Codes are 00, 02, 05, 07, 09, 13, 14, and 99

00 = No prenatal care 99 = Unknown

Validation Required

None

Cross Reference(s)

If Principal Source of Payment for Prenatal Care (25D) is equal to “00”, Date First Prenatal Care Visit (25AA) and Date Last Prenatal Care Visit (25BA) must contain “0000-00-00”, the Month Prenatal Care Began (25B) and Number of Prenatal Care Visits (25C) must be equal to “00”. If Principal Source of Payment for Prenatal Care (25D) contains a value other than “00”, Date First Prenatal Care Visit (25AA) and Date Last Prenatal Care Visit (25BA) must contain a date or all dashes, the Month Prenatal Care Began (25B) and Number of Prenatal Care Visits (25C) must contain a value other than “00”.


1/07 PRINCIPAL SOURCE OF PAYMENT FOR PRENATAL CARE


EDIT SPECIFICATIONS


PRINCIPAL SOURCE OF PAYMENT FOR PRENATAL CARE


Yes


If the principal source of payment for prenatal care is unknown, “Unknown” would be entered on the paper certificate and the electronic file would be coded “99”. If there was no principal source of payment for prenatal care, the paper certificate would show “00”.

1/07 PRINCIPAL SOURCE OF PAYMENT FOR PRENATAL CARE


EDIT SPECIFICATIONS

Data Element BIRTHWEIGHT

Definition The birthweight of this child in grams.

Field Number 26


4


1349-1352

Edit Criteria Valid codes are 0001-9999.


Validation Required

If the Birthweight is less than 1000 grams and no Date of Death (15A) is entered. If the Birthweight is greater than 6500 grams. If Days of Gestation (GAGE) is less than 140 days, or Obstetric Estimate of Gestation (26A) is less than 20 weeks, and Birthweight is greater than 2000 grams. If Days of Gestation (GAGE) is less than 168 days, or Obstetric Estimate of Gestation (26A) is less than 24 weeks, and Birthweight is greater than 3000 grams. If Days of Gestation (GAGE) is less than 196 days, or Obstetric Estimate of Gestation (26A) is less than 28 weeks, and Birthweight is greater than 4000 grams. If the code 9999 is entered.

Cross Reference(s)

A Birthweight that is unknown (9999) is only acceptable when the birth was a non-hospital (Box A = 0000), in transit (Box A = 0998), or a non-California (Box A = 9999) birth.


1/07 BIRTHWEIGHT


EDIT SPECIFICATIONS


BIRTHWEIGHT


Yes


If Birthweight is unknown, the paper certificate will reflect “Unknown” and the electronic record must contain 9999.

1/07 BIRTHWEIGHT


EDIT SPECIFICATIONS

1/07 OBSTETRIC ESTIMATE OF GESTATION AT DELIVERY –COMPLETED WEEKS

Data Element OBSTETRIC ESTIMATE OF GESTATION AT DELIVERY –

COMPLETED WEEKS

Definition The obstetric estimate of the infant’s gestation in completed weeks.

Field Number 26A


2


1353-1354


00 = unknown 01-52 = estimated length of gestation

Validation Required

If Obstetric Estimate of Gestation is less than 17 weeks. If Obstetric Estimate of Gestation is greater than 47 weeks.

Cross Reference(s)

None



EDIT SPECIFICATIONS

1/07 OBSTETRIC ESTIMATE OF GESTATION AT DELIVERY –COMPLETED WEEKS


OBSTETRIC ESTIMATE OF GESTATION AT DELIVERY – COMPLETED WEEKS


Yes


If the Obstetric Estimate of Gestation at Delivery is unknown, the paper certificate will state “Unknown” in this field. The electronic record will be “00”.


EDIT SPECIFICATIONS

Data Element DAYS OF GESTATION

Definition The period in uterus from date of last normal menses to date of birth.

Field Name GAGE


3


1355-1357

Valid codes are 000-999. 000 = Data not available for generation 001-998 = Generated length of gestation in days 999 = 999 days or more

Edit Criteria

Generate the “Days of Gestation” field by subtracting the Date Last Normal Menses Began (25A) from the Date of Birth (4A). If the Date Last Normal Menses Began (25A) is dashes, assign a zero value to the “Days of Gestation”. If the calculated “Days of Gestation” is greater than 999, assign the value 999 to this field.

Validation Required

If “Days of Gestation” is less than 140 days, and the Birthweight (26) is greater than 2000 grams. If “Days of Gestation” is less than 168 days, and the Birthweight (26) is greater than 3000 grams. If “Days of Gestation” is less than 196 days, and Birthweight (26) is greater than 4000 grams.

Cross Reference(s)

Cross references with “Days of Gestation” are automatic because this is a generated field.


1/07 DAYS OF GESTATION


EDIT SPECIFICATIONS


DAYS OF GESTATION


Yes

1/07 DAYS OF GESTATION


EDIT SPECIFICATIONS

Data Element HEARING SCREENING

Definition The results of the newborn hearing screen test.

Field Number 26B


24


1358-1381


PASS (BOTH EARS) REFER (ONE EAR) REFER (BOTH EARS) RESULTS PENDING WAIVED NOT MED INDICATED TEST NOT AVAILABLE

Validation Required

None

Cross Reference(s)

None


Yes

1/07 HEARING SCREENING


EDIT SPECIFICATIONS

Data Element PREVIOUS LIVE BIRTHS – NUMBER NOW LIVING

Definition This number indicates all births now living except this child. If this child is a

subsequent mate of a multiple birth (twin, triplet, etc.), include the prior live born mate(s) now living.

Field Number 27A


2


1382-1383

Edit Criteria Valid codes are 00-30 and 99.


Validation Required

If the values 10-30 are entered. If the following conditions exist:

AGE OF MOTHER PREVIOUS LIVE BIRTHS (27A + 27B)Under 15 one or more 15-16 two or more 17 three or more 18-19 four or more See Complications of Pregnancy and Concurrent Illness (29) validation requirements.


1/07 PREVIOUS LIVE BIRTHS – NUMBER NOW LIVING


EDIT SPECIFICATIONS


PREVIOUS LIVE BIRTHS – NUMBER NOW LIVING

Cross Reference(s)

If Date of Last Live Birth (27C) is given, then Number of Previous Live Births (living and dead) (27A + 27B) must be greater than zero. If Final Delivery Route 28A(A) contains code 02, 12, 22, 32, 04, 15, or 16, one of the following 4 fields must have a value greater than zero: 27A, 27B, 27D, 27E.


Yes


If the Number of Live Births Now Living is unknown, the paper certificate will show “Unknown” and the electronic file will be coded “99”.

1/07 PREVIOUS LIVE BIRTHS – NUMBER NOW LIVING


EDIT SPECIFICATIONS

Data Element PREVIOUS LIVE BIRTHS – NUMBER NOW DEAD

Definition This number indicates all live births now dead. If this child is a subsequent

mate of a multiple birth (twin, triplet, etc.), include the prior live born mate(s) now dead.

Field Number 27B


2


1384-1385


98 = Not Stated 99 = Unknown Right justify, left fill with zeros.

Validation Required


AGE OF MOTHER PREVIOUS LIVE BIRTHS (27A + 27B)Under 15 one or more 15-16 two or more 17 three or more 18-19 four or more See Complications of Pregnancy and Concurrent Illness (29) validation requirements.


1/07 PREVIOUS LIVE BIRTHS – NUMBER NOW DEAD


EDIT SPECIFICATIONS


PREVIOUS LIVE BIRTHS – NUMBER NOW DEAD

Cross Reference(s)

If Date of Last Live Birth (27C) is given, then Number of Previous Live Births (living and dead) (27A + 27B) must be greater than zero. If Final Delivery Route 28A(A) contains code 02, 12, 22, 32, 04, 15, or 16, one of the following 4 fields must have a value greater than zero: 27A, 27B, 27D, 27E.


Yes


If the Number of Live Births Now Dead is unknown, the paper certificate will show “Unk” and the electronic file will be coded “99”.

1/07 PREVIOUS LIVE BIRTHS – NUMBER NOW DEAD


EDIT SPECIFICATIONS

Data Element DATE OF LAST LIVE BIRTH – MONTH, DAY, YEAR

Definition The month, day, and year of last live birth. If a subsequent mate of a multiple

birth, enter the birth date of the prior born (almost always same day).

Field Number 27C


10


1386-1395



CC = Century 19, 20 YY = Year 00-99 MM = Month 01-12 Right justify, left fill with zeros. DD = Day 01-31 Depending on the month and allowing

for leap year.

Validation Required

If the Date of Last Live Birth precedes the Date of Birth (4A) by more than 35 years. If the Date of Last Live Birth differs from the Date of Last Other Termination (27F) by more than 35 years. If Item 3A is “single” or Item 3B is “1”, and the Date of Last Live Birth is less than 9 months prior to the Date of Birth (4A).


1/07 DATE OF LAST LIVE BIRTH – MONTH, DAY, YEAR


EDIT SPECIFICATIONS


DATE OF LAST LIVE BIRTH – MONTH, DAY, YEAR

Cross Reference(s)

Date of Last Live Birth may not be greater than Date of Birth (4A). If Date of Last Live Birth is given, then number of Previous Live Births (27A + 27B) must be greater than zero.


Yes


In this field the electronic representation of the Date of Last Live Birth is in the format as previously stated. However, the paper certificate will be in the format of MM/DD/CCYY.

Example: 08-24-2001 Month = 01-12 Slash = / Day = 01-31 Slash = / Year = Numeric (four digits of year) Incomplete Dates: If the Date of Last Live Birth is unknown, the paper certificate will state “Unknown” in this field. The electronic record will be all dashes. If the month is unknown, month on the paper certificate and the electronic record will be “--”. If the day is unknown, day on the paper certificate and the electronic record will be “--”. If number of Previous Live Births (27A + 27B) is zero, Date of Last Live Birth (27C) will be a dash on the paper certificate and all dashes on the electronic record.

1/07 DATE OF LAST LIVE BIRTH – MONTH, DAY, YEAR


EDIT SPECIFICATIONS

Data Element OTHER TERMINATIONS – NUMBER BEFORE 20 WEEKS

Definition This number indicates all spontaneous terminations that occurred prior to 20

weeks into pregnancy (gestation). For each multiple pregnancy count every fetus.

Field Number 27D


2


1396-1397



Validation Required


AGE OF MOTHER OTHER TERMINATIONS (27D + 27E)Under 15 one or more 15-16 two or more 17 three or more 18-19 four or more See Complications of Pregnancy and Concurrent Illness (29) validation requirements.


1/07 OTHER TERMINATIONS – NUMBER BEFORE 20 WEEKS


EDIT SPECIFICATIONS


OTHER TERMINATIONS – NUMBER BEFORE 20 WEEKS

Cross Reference(s)

If Date of Last Other Termination of Pregnancy (27F) is given, then number of Other Terminations (27D + 27E) must be greater than zero. If Final Delivery Route 28A(A) contains code 02, 12, 22, 32, 04, 15, or 16, one of the following 4 fields must have a value greater than zero: 27A, 27B, 27D, 27E.


Yes


If the number of Other Terminations Before 20 Weeks is unknown the paper certificate will show “Unknown” and the electronic file will be coded “99”.

1/07 OTHER TERMINATIONS – NUMBER BEFORE 20 WEEKS


EDIT SPECIFICATIONS

Data Element OTHER TERMINATIONS – NUMBER AFTER 20 WEEKS

Definition This number indicates all spontaneous terminations that occurred 20 weeks

into pregnancy (gestation) and after. For each multiple pregnancy, count every fetus.

Field Number 27E


2


1398-1399



Validation Required


AGE OF MOTHER OTHER TERMINATIONS (27D + 27E)Under 15 one or more 15-16 two or more 17 three or more 18-19 four or more See Complications of Pregnancy and Concurrent Illness (29) validation requirements.


1/07 OTHER TERMINATIONS – NUMBER AFTER 20 WEEKS


EDIT SPECIFICATIONS


OTHER TERMINATIONS – NUMBER AFTER 20 WEEKS

Cross Reference(s)

If Date of Last Other Termination of Pregnancy (27F) is given then number of Other Terminations (27D + 27E) must be greater than zero. If Final Delivery Route 28A(A) contains code 02, 12, 22, 32, 04, 15, or 16, one of the following 4 fields must have a value greater than zero: 27A, 27B, 27D, 27E.


Yes


If the number of Other Terminations After 20 Weeks is unknown, the paper certificate will show “Unknown” and the electronic file will be coded “99”.

1/07 OTHER TERMINATIONS – NUMBER AFTER 20 WEEKS


EDIT SPECIFICATIONS

Data Element DATE OF LAST OTHER TERMINATION – MONTH, YEAR

Definition The month and year of termination other than live births or induced

terminations.

Field Number 27F


10


1400-1409


CCYY-MM---. Dashes must be included as shown below. Example: 2003-07---

CC = Century 19, 20 YY = Year 00-99 MM = Month 01-12 Right justify, left fill with zeros.

Validation Required

If the Date of Last Other Termination precedes the Date of Birth (4A) by more than 35 years, the information must be validated. If the Date of Last Live Birth (27F) differs from the Date of Last Other Termination by more than 35 years.

Cross Reference(s)

Date of Last Other Termination may not be greater than Date of Birth (4A). If Date of Last Other Termination is given, then number of Other Terminations (27D + 27E) must be greater than zero.


1/07 DATE OF LAST OTHER TERMINATION – MONTH, YEAR


EDIT SPECIFICATIONS


DATE OF LAST OTHER TERMINATION – MONTH, YEAR


Yes


In this field the electronic representation of the Date of Last Other Termination is in the format as previously stated. However, the paper certificate will be in the format of MM/CCYY.

Example: 07/2003 Month = 01-12 Slash = / Year = Numeric (four digits of year) Incomplete Dates: If the Date of Last Other Termination is unknown, the paper certificate will state “Unknown” in this field. The electronic record will be all dashes. If the month is unknown, month on the paper certificate and the electronic record will be “--”. The day on the electronic record will always be “--”. If the number of Other Terminations (27D + 27E) is zero, Date of Last Live Birth (27C) will be all dashes on the electronic record and a dash on the paper certificate.

1/07 DATE OF LAST OTHER TERMINATION – MONTH, YEAR


EDIT SPECIFICATIONS

Data Element TOTAL LIVE BIRTHS

Definition Total number of all children born alive to this mother, whether children are

currently living or dead (including this birth event).

Field Name TLB


2


1410-1411

Edit Criteria Generate a value for this field by summing the values for Live Births Now

Living (27A) and Live Births Now Dead (27B), plus 1 (for this birth). If any of the fields which are summed to generate this one has a value of “99”, set the value for this field to “99” (unknown or unable to compute). If the “Total Live Births” field is not within the range of 1 through 60 inclusive, set to “99”. Valid codes are: 01-60 = Generated number of children 99 = Unknown or unable to compute

This sum is coded “99” for unknown if any of the variables used in the computation is coded “99”.

Validation Required

None

Cross Reference(s)

None


Yes

1/07 TOTAL LIVE BIRTHS


EDIT SPECIFICATIONS

Data Element TOTAL CHILDREN EVER BORN

Definition Total number of all children living or dead, born to this mother (including this

birth event).

Field Name TCB


2


1412-1413

Edit Criteria Generate the value for this field by summing the values for Live Births Now

Living (27A), Live Births Now Dead (27B), and Terminations after 20Wks (27E) plus “1” (for this birth). If any of the fields which are summed to generate this one has a value of “99”, set the value for this field to “99” (unknown or unable to compute). If the “Total Children Ever Born” field is not within the range of 1 through 98 inclusive, set to “99”. Valid codes are: 01-98 = Generated number of children 99 = Unknown or unable to compute

This sum is coded “99” for unknown if any of the variables used in the computation is coded “99”.

Validation Required

None

Cross Reference(s)

None


1/07 TOTAL CHILDREN EVER BORN


EDIT SPECIFICATIONS


TOTAL CHILDREN EVER BORN


Yes

1/07 TOTAL CHILDREN EVER BORN


EDIT SPECIFICATIONS

Data Element METHOD OF DELIVERY: FINAL DELIVERY ROUTE

Definition The code representing final delivery route. Enter only one code.

Field Number 28A(A)


2


1414-1415

Edit Criteria Valid codes are:

01 = Cesarean – primary 11 = Cesarean – primary, with trial of labor attempted 21 = Cesarean – primary, with vacuum 31 = Cesarean – primary, with vacuum & trial of labor attempted 02 = Cesarean – repeat 12 = Cesarean – repeat, with trial of labor attempted 22 = Cesarean – repeat, with vacuum 32 = Cesarean – repeat, with vacuum & trial of labor attempted 03 = Vaginal – spontaneous 04 = Vaginal – spontaneous, after previous Cesarean 05 = Vaginal – forceps 15 = Vaginal – forceps, after previous Cesarean 06 = Vaginal – vacuum 16 = Vaginal – vacuum, after previous Cesarean

Validation Required

None

Cross Reference(s)

If Final Delivery Route 28A(A) contains code 02, 12, 22, 32, 04, 15, or 16, one of the following four fields must have a value greater than zero: 27A, 27B, 27D, 27E.


1/07 METHOD OF DELIVERY


EDIT SPECIFICATIONS


METHOD OF DELIVERY: FINAL DELIVERY ROUTE


Yes


The paper certificate will reflect the appropriate two-digit code, followed by a comma, to indicate the final delivery route. The electronic record will reflect the two-digit code.



EDIT SPECIFICATIONS

Data Element METHOD OF DELIVERY: IF MOTHER HAD A PREVIOUS CESAREAN

– HOW MANY?

Definition The code representing the number of previous Cesareans.

Field Number 28A(B)


1


1416-1416

Edit Criteria Valid entries are 0-9 and U.

U = Unknown

Validation Required

None

Cross Reference(s)

Enter 0 if 01, 11, 21, 31, 03, 05 or 06 is reported in 28A(A). Enter 1-9 or U if 02, 12, 22, 32, 04, 15 or 16 is reported in 28A(A).


Yes


If there have been more than 9 previous Cesareans, enter 9. The paper certificate will reflect the appropriate one-digit number or U, followed by a comma. The electronic record will reflect the appropriate one-digit number or U.



EDIT SPECIFICATIONS

Data Element METHOD OF DELIVERY: FETAL PRESENTATION AT BIRTH

Definition The code representing the fetal presentation at birth.

Field Number 28A(C)


1


1417-1417

Edit Criteria Valid paper certificate codes are 20, 30, 40, and 90.

20 = Cephalic fetal presentation at delivery 30 = Breech fetal presentation at delivery 40 = Other fetal presentation at delivery 90 = Unknown

Validation Required

None

Cross Reference(s)

None


Yes


The paper certificate will reflect the appropriate two-digit code to indicate the fetal presentation at birth. The electronic record will reflect the first digit of the code (2, 3, 4 or 9).



EDIT SPECIFICATIONS


Data Element METHOD OF DELIVERY: WAS VAGINAL DELIVERY WITH

FORCEPS ATTEMPTED, BUT UNSUCCESSFUL?

Definition The code indicating whether or not vaginal delivery with forceps was

attempted, but was unsuccessful.

Field Number 28A(D)


1


1418-1418

Edit Criteria Valid paper certificate codes are 50, 58 or 59

50 = Yes 58 = No 59 = Unknown

Validation Required

None

Cross Reference(s)

Enter 58 if 05 or 15 is reported in 28A(A).


Yes


The paper certificate will reflect the appropriate two-digit code, followed by a comma, to indicate whether or not vaginal delivery with forceps was attempted, but was unsuccessful. The electronic record will reflect the last digit of the code (0, 8, or 9).


EDIT SPECIFICATIONS


Data Element METHOD OF DELIVERY: WAS VAGINAL DELIVERY WITH

VACUUM ATTEMPTED, BUT UNSUCCESSFUL?

Definition The code indicating whether or not vaginal delivery with vacuum was

attempted, but was unsuccessful.

Field Number 28A(E)


1


1419-1419

Edit Criteria Valid paper certificate codes are 60, 68, or 69

60 = Yes 68 = No 69 = Unknown

Validation Required

None

Cross Reference(s)

Enter 68 if 06 or 16 is reported in 28A(A).


Yes


The paper certificate will reflect the appropriate two-digit code, followed by a comma, to indicate whether or not vaginal delivery with vacuum was attempted, but was unsuccessful. The electronic record will reflect the last digit of the code (0, 8, or 9).


EDIT SPECIFICATIONS

1/07 EXPECTED SOURCE OF PAYMENT FOR DELIVERY

Data Element EXPECTED SOURCE OF PAYMENT FOR DELIVERY

Definition The code representing the expected principal source of payment as defined in

Appendix A.

Field Number 28B


2


1420-1421

Edit Criteria Valid codes are 00, 02, 05, 07, 09, 14, 15, 16, and 99.

00 = Medically unattended birth 99 = Unknown

Validation Required

None

Cross Reference(s)

None


Yes


If there was no payment for delivery, e.g. for a home birth, code “00”. If the Principal Source of Payment for Delivery is coded “00” (medically unattended birth), and the birth occurred in a California maternity hospital (Box A), then recode Expected Source of Payment of Delivery to 99 (unknown).


EDIT SPECIFICATIONS

1/07 COMPLICATIONS AND PROCEDURES OF PREGNANCY…

Data Element COMPLICATIONS AND PROCEDURES OF PREGNANCY AND

CONCURRENT ILLNESS

Definition The code representing complications and procedures as defined in Appendix

D.

Field Number 29


32 (16 sets of 2)


1422-1453

Edit Criteria See Appendix D for valid codes and definitions.

Codes 01 and 03 are mutually exclusive, only one of these two codes may be entered. Codes 37 and 38 are mutually exclusive, only one of these two codes may be entered. Codes 00 (None) and 99 (Unknown) are accepted only as the first 2 characters and cannot be followed by any other entry except trailing zeros. Left justify with trailing zeros.

Validation Required

If Complications and Procedures of Pregnancy and Concurrent Illness (29) indicates a previous pregnancy (codes 23 or 36) and the sum of 27A + 27B + 27D + 27E is less than one.

Cross Reference(s)

None



EDIT SPECIFICATIONS

1/07 COMPLICATIONS AND PROCEDURES OF PREGNANCY…


COMPLICATIONS AND PROCEDURES OF PREGNANCY AND CONCURRENT ILLNESS


Yes


If this information is not known, enter “Unknown” on the paper certificate, and “99” followed by trailing zeros on the electronic file. When multiple codes are entered on the paper certificate, separate each two-digit code with a comma.


EDIT SPECIFICATIONS

1/07 COMPLICATIONS AND PROCEDURES OF LABOR AND DELIVERY

Data Element COMPLICATIONS AND PROCEDURES OF LABOR AND DELIVERY

Definition The code representing complications and procedures as defined in Appendix

D.

Field Number 30


18 (9 sets of 2)


1454-1471


Codes 00 (None) and 99 (Unknown) are accepted only as the first 2 characters and cannot be followed by any other entry except trailing zeros. Left justify codes with trailing zeros.

Validation Required

None

Cross Reference(s)

None


Yes




EDIT SPECIFICATIONS

1/07 ABNORMAL CONDITIONS AND CLINICAL PROCEDURES…

Data Element ABNORMAL CONDITIONS AND CLINICAL PROCEDURES RELATED

TO THE NEWBORN

Definition Abnormal conditions and clinical procedures relating to the newborn as

defined in Appendix D.

Field Number 31


20 (10 sets of 2)


1472-1491


Codes 57 and 81 are mutually exclusive, only one of these two codes may be entered. Codes 82 and 83 are mutually exclusive, only one of these two codes may be entered. Codes 00 (None) and 99 (Unknown) are accepted only as the first 2 characters and cannot be followed by any other entry except trailing zeros. Left justify codes with trailing zeros.

Validation Required

None

Cross Reference(s)

None



EDIT SPECIFICATIONS

1/07 ABNORMAL CONDITIONS AND CLINICAL PROCEDURES…


ABNORMAL CONDITIONS AND CLINICAL PROCEDURES RELATED TO THE NEWBORN


Yes




EDIT SPECIFICATIONS

1/07 SSN (OF FATHER/PARENT)

Data Element SSN (OF FATHER/PARENT)

Definition The Social Security Number of the baby’s father.

Field Number 32


9


1492-1500

Edit Criteria Valid entries are 9 numerals, 0-9 and not all zeros within any segment,

“Unknown”, “Withheld”, or “None”.

Validation Required

None

Cross Reference(s)

None


Yes


The paper will reflect the standard SSN format NNN-NN-NNNN.


EDIT SPECIFICATIONS

1/07 SSN (OF MOTHER/PARENT)

Data Element SSN (OF MOTHER/PARENT)

Definition The Social Security Number of the baby’s mother.

Field Number 33


9


1501-1509

Edit Criteria Valid entries are 9 numerals, 0-9 and not all zeros within any segment,

“Unknown”, “Withheld”, “None”.

Validation Required

None

Cross Reference(s)

None


Yes


The paper will reflect the standard SSN format NNN-NN-NNNN.


EDIT SPECIFICATIONS

1/07 MATERNITY HOSPITAL CODE (BOX A)

Data Element MATERNITY HOSPITAL CODE (BOX A)

Definition The code assigned to the hospital or place of birth as reported in Place of

Birth (5A).

Field Name A


4


1510-1513

Edit Criteria See Appendix E for codes. Valid codes are 0000-9999.

0000 = Non-Hospital births, either in-state or reallocates from out-of-state. 0998 = Births in transit. For example, births occurring in taxis. 0999 = Unknown or new hospital births in-state. This includes some birthing centers. 9999 = Unknown hospital births, out-of-state only (reallocates). Right justify, left fill with zeros.

Validation Required

None

Cross Reference(s)

A Birthweight (26) that is unknown (9999) is only acceptable when the Box A code is 0000, 0998, 0999 or 9999. The maternity hospital code must be valid for the County of Birth Occurrence (5D).


Yes



EDIT SPECIFICATIONS

1/07 MATERNITY HOSPITAL CODE (BOX A)


MATERNITY HOSPITAL CODE (BOX A)


Box A is required on paper certificates.


EDIT SPECIFICATIONS

1/07 PLACE OF MOTHER’S RESIDENCE CODE (BOX B)

Data Element PLACE OF MOTHER’S RESIDENCE CODE (BOX B)

Definition The code assigned to the California county, Canadian province, U.S. state,

U.S. territory, or foreign country where the mother usually resides.

Field Name B


3


1514-1516

Edit Criteria The code that corresponds to the California residence county or Canadian

residence province (24B) of the mother. If the mother resides outside of California or Canada, the code corresponds to the residence U.S. state, U.S. territory, or foreign country (24D) of the mother. See Appendix F for California county codes, and Appendix B for U.S. state and MARC U.S. territory/Canadian province/foreign country codes. Alphabetic values are left justified with trailing blanks.

Validation Required

None

Cross Reference(s)

None


Yes



EDIT SPECIFICATIONS

1/07 PLACE OF MOTHER’S RESIDENCE CODE (BOX B)


PLACE OF MOTHER’S RESIDENCE CODE (BOX B)


If the mother’s County/Province of Residence (24B) is unknown, and the State/Foreign Country of Residence (24D) is California, then code Box B to the County of Birth Occurrence (5D) code. If the mother’s County/Province of Residence (24B) is unknown, and State/Foreign Country of Residence (24D) is Canada, then code Box B to CN blank. If the mother’s State/Foreign Country of Residence (24D) is unknown, then code Box B to XX blank.


EDIT SPECIFICATIONS

1/07 CENSUS TRACT

Data Element CENSUS TRACT

Definition A code, based on the most recent publication of Census Tracts, indicating a

specific geographic location.

Field Name CT


6


1517-1522

Edit Criteria This field is not edited. The various counties opting to code this field code

according to their own coding scheme. Left justify with trailing blanks or all blanks.

Validation Required

None

Cross Reference(s)

None


Yes


EDIT SPECIFICATIONS

1/07 FIPS CITY PLACE CODE (OF RESIDENCE OF MOTHER)

Data Element FIPS CITY PLACE CODE (OF RESIDENCE OF MOTHER)

Definition The Federal Information Processing Standards (FIPS) code for the city place

within the United States in which the mother usually resides.

Field Name FIPS1


5


1523-1527

Edit Criteria The FIPS numeric code that corresponds to the residence city (24C) of the

mother. If the country code is U.S., but the city place code is unknown, code city place to 99999. If the country is coded to a country other than the U.S., code city place to 00000. If the country code is unknown, code city place to 99999.

Validation Required

None

Cross Reference(s)

None


Yes


EDIT SPECIFICATIONS

1/07 FIPS COUNTY PLACE CODE (OF RESIDENCE OF MOTHER)

Data Element FIPS COUNTY PLACE CODE (OF RESIDENCE OF MOTHER)

Definition The Federal Information Processing Standards (FIPS) code for the county

within the United States in which the mother usually resides.

Field Name FIPS2


3


1528-1530

Edit Criteria The FIPS numeric code that corresponds to the residence county (24B) of the

mother. If the country code is U.S., but the county code is unknown, code county to 999. If the country is coded to a country other than the U.S., code county to 000. If the country code is unknown, code county to 999.

Validation Required

None

Cross Reference(s)

None


Yes


EDIT SPECIFICATIONS

1/07 TYPE OF ATTENDANT/CERTIFIER CODE (BOX D)

Data Element TYPE OF ATTENDANT/CERTIFIER CODE (BOX D)

Definition A code assigned to the attendant or certifier signing in Item 13A.

Field Name D


1


1531-1531


1 = Medical Doctor 2 = Doctor of Osteopathy 3 = Certified Nurse Midwife 4 = Registered Nurse/Licensed Midwife/Physician’s Assistant 5 = Other Midwife 6 = Other 9 = Unknown or Unattended See Appendix G for expanded list of codes.

Validation Required

None

Cross Reference(s)

None


Yes


Box D is required on an automated paper certificate.


EDIT SPECIFICATIONS

1/07 ENUMERATION AT BIRTH (BOX F)

Data Element ENUMERATION AT BIRTH (BOX F)

Definition Codes indicating the parents desire to have this birth information (1) sent to

the Social Security Administration for the issuance of a Social Security Number for the child and (2) allow this number to be provided to DHS.

Field Name F

Field Length 2


1532-1533 1st position is code for Answer #1 2nd position is code of Answer #2

Edit Criteria Valid entries are: YY

YN NN Default entry is NN. Other entries require a signed parental authorization on file at the hospital.

Validation Required

None

Cross Reference(s)

If child’s name (1A and 1C) is blank, or if Date of Death (15A) has a date entry, Box F must be coded NN.


Yes


EDIT SPECIFICATIONS

1/07 SSN (OF CHILD)

Data Element SSN (OF CHILD)

Definition Reserved for future State use.

Field Number CSSN


9


1534-1542

Edit Criteria Fill with blanks.

Validation Required

None

Cross Reference(s)

None


No


EDIT SPECIFICATIONS

1/07 APGAR SCORE AT ONE MINUTE

Data Element APGAR SCORE AT ONE MINUTE

Definition The APGAR score for this child at one minute after birth.

Field Name APGAR1


2

Record Position EDP Record)

1543-1544


01-10 = One minute score 99 = Unknown or not taken

Right justify, left fill with zeros.

Validation Required

None

Cross Reference(s)

None


Yes


EDIT SPECIFICATIONS

1/07 APGAR SCORE AT FIVE MINUTES

Data Element APGAR SCORE AT FIVE MINUTES

Definition The APGAR score for this child at five minutes after birth.

Field Name APGAR5


2


1545-1546


01-10 = Five minute score 99 = Unknown or not taken


Validation Required

None

Cross Reference(s)

None


Yes


EDIT SPECIFICATIONS

1/07 APGAR SCORE AT TEN MINUTES

Data Element APGAR SCORE AT TEN MINUTES

Definition The APGAR score for this child at ten minutes after birth.

Field Name APGAR10


2


1547-1548


01-10 = Ten minute score 99 = Unknown or not taken


Validation Required

None

Cross Reference(s)

None


Yes


EDIT SPECIFICATIONS

1/07 CIGARETTE SMOKING THREE MONTHS BEFORE PREGNANCY

Data Element CIGARETTE SMOKING THREE MONTHS BEFORE PREGNANCY

Definition The average number of cigarettes that the mother smoked per day during the

three months prior to becoming pregnant with this child.

Field Name CIGPN


2


1549-1550


00-98 = Cigarettes smoked per day 99 = Unknown


Validation Required

None

Cross Reference(s)

None


Yes


If packs of cigarettes are reported, convert packs smoked to cigarettes smoked, at the rate of 20 cigarettes per pack.


EDIT SPECIFICATIONS

1/07 CIGARETTE SMOKING DURING FIRST THREE MONTHS OF PREGNANCY

Data Element CIGARETTE SMOKING DURING FIRST THREE MONTHS OF

PREGNANCY


first three months of pregnancy with this child.

Field Name CIGFN


2


1551-1552




Validation Required

None

Cross Reference(s)

None


Yes




EDIT SPECIFICATIONS

1/07 CIGARETTE SMOKING DURING SECOND THREE MONTHS OF PREGNANCY

Data Element CIGARETTE SMOKING DURING SECOND THREE MONTHS OF

PREGNANCY


second 3 months of pregnancy with this child.

Field Name CIGSN


2


1553-1554




Validation Required

None

Cross Reference(s)

None


Yes




EDIT SPECIFICATIONS

1/07 CIGARETTE SMOKING DURING THIRD TRIMESTER OF PREGNANCY

Data Element CIGARETTE SMOKING DURING THIRD TRIMESTER OF

PREGNANCY


third trimester of pregnancy with this child.

Field Name CIGTN


2


1555-1556




Validation Required

None

Cross Reference(s)

None


Yes




EDIT SPECIFICATIONS

1/07 DECLARATION OF PATERNITY

Data Element DECLARATION OF PATERNITY

Definition Indicates whether or not a voluntary declaration of paternity has been

prepared.

Field Name DECP


1


1557-1557


Y = Yes, a declaration has been prepared N = No, a declaration has not been prepared Blank = MAR is coded “1”

Validation Required

None

Cross Reference(s)

If Mother Married (MAR) is coded 2 or 9, and Declaration of Paternity (DECP) is coded “N”, then Father’s Name (6A, 6B, 6C) must contain a dash. If Mother Married (MAR) is coded “1”, Declaration of Paternity (DECP) will be blank.


Yes


EDIT SPECIFICATIONS

1/07 MOTHER MARRIED

Data Element MOTHER MARRIED

Definition The mother’s indication of whether or not she was married at any time during

the pregnancy.

Field Name MAR


1


1558-1558

Edit Criteria Valid codes are 1, 2, and 9

1 = Married 2 = Not Married 9 = Unknown

Validation Required

None

Cross Reference(s)

If Mother Married (MAR) is coded 2 or 9, and Declaration of Paternity (DECP) is coded “N”, then Father’s Name (6A, 6B, 6C) must contain a dash. If Mother Married (MAR) is coded “1”, Declaration of Paternity (DECP) will be blank.


Yes


EDIT SPECIFICATIONS

1/07 STREET, NUMBER, OR PO BOX (MAILING ADDRESS OF MOTHER)

Data Element STREET, NUMBER, OR POST OFFICE BOX (MAILING ADDRESS OF

MOTHER)

Definition The street number and name, or post office box at the location where the

mother receives mail.

Field Name MSTREET


50


1559-1608


Validation Required

None

Cross Reference(s)

None


Yes


If the mother’s residence and mailing address are the same, the residence street and number (24A) will appear in this field.


EDIT SPECIFICATIONS

1/07 CITY (MAILING ADDRESS OF MOTHER)

Data Element CITY (MAILING ADDRESS OF MOTHER)

Definition The city or town in which the mother receives mail.

Field Name MCITY


35


1609-1643


Validation Required

None

Cross Reference(s)

None


Yes


If the mother’s residence and mailing address are the same, the residence city (24C) will appear in this field.


EDIT SPECIFICATIONS

1/07 COUNTY (MAILING ADDRESS OF MOTHER)

Data Element COUNTY (MAILING ADDRESS OF MOTHER)

Definition The county in which the mother receives mail.

Field Name MCOUNTY


30


1644-1673


Validation Required

None

Cross Reference(s)

None


Yes


If the mother’s residence and mailing address are the same, the residence county (24B) will appear in this field.


EDIT SPECIFICATIONS

1/07 STATE (MAILING ADDRESS OF MOTHER)

Data Element STATE (MAILING ADDRESS OF MOTHER)

Definition The U.S. state, U.S. territory, or foreign country in which the mother receives

mail.

Field Name MSTATE


25


1674-1698


Validation Required

None

Cross Reference(s)

If the code in State Mailing Address of Mother (MSTATE) is not a U.S. state, American Samoa, Guam, Puerto Rico, or Virgin Islands, set ZIP Code Mailing Address of Mother (MZIP) to zeros.


Yes


If the mother’s residence and mailing address are the same, the residence state (24D) will appear in this field.


EDIT SPECIFICATIONS

1/07 ZIP CODE (MAILING ADDRESS OF MOTHER)

Data Element ZIP CODE (U.S. MAILING ADDRESS OF MOTHER)

Definition The ZIP code where the mother receives mail.

Field Name MZIP


5


1699-1703

Edit Criteria Valid entries are all blank or all numeric.

Five characters = ZIP code

Validation Required

None

Cross Reference(s)

If the code in State Mailing Address of Mother (MSTATE) is not a U.S. state, American Samoa, Guam, Puerto Rico, or Virgin Islands, set ZIP Code Mailing Address of Mother (MZIP) to zeros.


Yes


If the mother’s residence and mailing address are the same, the residence ZIP code (24E) will appear in this field. If ZIP code is unknown, this field will be blank.


EDIT SPECIFICATIONS

1/07 MOTHER’S HEIGHT (FEET)

Data Element MOTHER’S HEIGHT (FEET)

Definition The mother’s height (feet component)

Field Name MHT1


1


1704-1704

Edit Criteria Valid entries are 1-8 and 9 (Unknown).

Validation Required

Values less than 3 or greater than 6 must be validated.

Cross Reference(s)

None


Yes


EDIT SPECIFICATIONS

1/07 MOTHER’S HEIGHT (INCHES 1-11)

Data Element MOTHER’S HEIGHT (INCHES 00-11)

Definition The mother’s height (inches component)

Field Name MHT2


2


1705-1706



Validation Required

None

Cross Reference(s)

None


Yes


EDIT SPECIFICATIONS

1/07 MOTHER’S PREPREGNANCY WEIGHT

Data Element MOTHER’S PREPREGNANCY WEIGHT

Definition The mother’s weight in pounds when she became pregnant with this child.

Field Name MWT1


3


1707-1709



Validation Required


Cross Reference(s)

None


Yes


EDIT SPECIFICATIONS

1/07 MOTHER’S WEIGHT AT DELIVERY

Data Element MOTHER’S WEIGHT AT DELIVERY

Definition The mother’s weight in pounds at the time of delivery.

Field Name MWT2


3


1710-1712



Validation Required


Cross Reference(s)

None


Yes


EDIT SPECIFICATIONS

1/07 DID MOTHER GET WIC FOOD FOR HERSELF DURING THIS PREGNANCY?

Data Element DID MOTHER GET WIC FOOD FOR HERSELF DURING THIS

PREGNANCY?

Definition Use of the Women, Infants’ and Children (WIC) nutritional program by the

mother during the pregnancy.

Field Name WIC


1


1713-1713

Edit Criteria Valid entries are Y, N, and U (Unknown)

Validation Required

None

Cross Reference(s)

None


Yes


EDIT SPECIFICATIONS

1/07 AMENDMENT INDICATOR

Data Element AMENDMENT INDICATOR

Definition An entry on the electronic record that indicates that the information was

obtained by entering data from both the birth certificate and an amendment.

Field Name AMEND


1


1714-1714

Edit Criteria This field may be blank or contain a “1”. A blank indicates no amendment

present. A “1” indicates that the original certificate was stamped “1 of 2” indicating the presence of an amendment.

Validation Required

None

Cross Reference(s)

None


Yes


EDIT SPECIFICATIONS

1/07 STATE/FOREIGN COUNTRY CODE (MAILING ADDRESS OF MOTHER)

Data Element STATE/FOREIGN COUNTRY CODE (MAILING ADDRESS OF

MOTHER)

Definition The code assigned to the U.S. state, U.S. territory or foreign country where

the mother receives mail, as reported in electronic item MSTATE.

Field Name MSCODE


3


1715-1717

Edit Criteria See Appendix B for U.S. state and MARC U.S. territory and foreign country

codes.

Validation Required

None

Cross Reference(s)

None


Yes


EDIT SPECIFICATIONS

1/07 PLANNED PLACE OF BIRTH CODE

Data Element PLANNED PLACE OF BIRTH CODE

Definition The code representing the place where the mother planned to deliver the

child, as indicated in Item 5E for pre 2007 births.

Field Name Box E


1


1718-1718

Edit Criteria Valid codes are 1-5 and 9, or blank for post 2006 births..

1 = Hospital 2 = Birth Center 3 = Residence 4 = Unplanned 5 = Other 9 = Unknown or not reported

Validation Required

None

Cross Reference(s)

None


Yes, for pre 2007 births.


Record Layout

1/07 RECORD LAYOUT

DATA ELEMENT FIELD

LENGTH POSITION

SFN State File Number 13 0001-0013

LFN Local Registration Number 13 0014-0026

1A Name of Child - First 30 0027-0056

1B Middle 24 0057-0080

1C Last 34 0081-0114

2 Sex 6 0115-0120

2 Sex Code 1 0121-0121

3A This Birth, Single, Twin, Etc. 12 0122-0133

3A Birth Type (Plurality) Code 1 0134-0134

3B If Multiple, This Child 1st, 2nd, Etc. 1 0135-0135

4A Date of Birth 10 0136-0145

4B Hour – 24 Hour Clock Time 4 0146-0149

5A Place of Birth – Name of Hospital/Facility 36 0150-0185

5B Street Address – Street, Number, or Location 44 0186-0229

5C City 36 0230-0265

5D County 16 0266-0281

5D County of Birth Code 3 0282-0284

6A Name of Father/Parent – First 20 0285-0304

6B Middle 15 0305-0319

6C Last 26 0320-0345

7 Father’s Birthplace 15 0346-0360

7 Father’s Birthplace Code 3 0361-0363

8 Father’s Date of Birth 10 0364-0373

FAGE Father’s Age 2 0374-0375

9A Name of Mother/Parent – First 20 0376-0395

9B Middle 15 0396-0410



Record Layout (continued)

1/07 RECORD LAYOUT

DATA ELEMENT FIELD

LENGTH POSITION

9C Last (Birth Name) 26 0411-0436

10 Mother’s Birthplace 15 0437-0451

10 Mother’s Birthplace Code 3 0452-0454

11 Mother’s Date of Birth 10 0455-0464

MAGE Mother’s Age 2 0465-0466

12A Parent or Other Informant - Signature 39 0467-0505

12B Relationship to Child 16 0506-0521

12B Relationship to Child Code 1 0522-0522

12C Date Signed (By Parent or Other Informant) 10 0523-0532

13B License Number (of Attendant) 13 0533-0545

13C Date Signed (By Attendant or Certifier) 10 0546-0555

13D Name, Title and Mailing Address of Attendant 60 0556-0615

14 Name/Title of Certifier if Other than Attendant 29 0616-0644

15A Date of Death 10 0645-0654

15B State File Number (of Death Certificate) 13 0655-0667

DI Death Indicator 1 0668-0668

16 Local Registrar – Signature 38 0669-0706

17 Date Accepted for Registration 10 0707-0716

18 Father’s Multiple Race Text with Delimiters 50 0717-0766

18 Father’s Multiple Race Text Values (3x16) 48 0767-0814

18 Father’s Multiple Race Codes (3x2) 6 0815-0820

19 Father Hispanic, Latino, or Spanish? 18 0821-0838

19 Hispanic Code (of Father) 1 0839-0839

20 Date Last Worked (of Father) 10 0840-0849

20A Usual Occupation (of Father) 39 0850-0888

20B Kind of Business or Industry/Father 36 0889-0924




1/07 RECORD LAYOUT

DATA ELEMENT FIELD

LENGTH POSITION

20C Education – Highest Level or Degree/Father 16 0925-0940

21 Mother’s Multiple Race Text with Delimiters 50 0941-0990

21 Mother’s Multiple Race Text Values (3x16) 48 0991-1038

21 Mother’s Multiple Race Codes (3x2) 6 1039-1044

22 Mother Hispanic, Latino, or Spanish? 18 1045-1062

22 Hispanic Code (of Mother) 1 1063-1063

23 Date Last Worked (of Mother) 10 1064-1073

23A Usual Occupation (of Mother) 39 1074-1112

23B Kind of Business or Industry/Mother 36 1113-1148

23C Education – Highest Level or Degree/Mother 16 1149-1164

24A Mother’s Residence Street Number or Location 50 1165-1214

24B County/Province 30 1215-1244

24C City 35 1245-1279

24D State/Foreign Country 25 1280-1304

24E ZIP Code 5 1305-1309

25A Date Last Normal Menses Began 10 1310-1319

25AA Date First Prenatal Care Visit 10 1320-1329

25B Month Prenatal Care Began 3 1330-1332

25B Month Prenatal Care Began Code 2 1333-1334

25BA Date Last Prenatal Care Visit 10 1335-1344

25C Number of Prenatal Care Visits 2 1345-1346

25D Principal Source of Payment for Prenatal Care 2 1347-1348

26 Birthweight 4 1349-1352

26A Obstetric Est. of Gestation at Delivery - Wks 2 1353-1354

GAGE Days Gestation From LMP to DOB 3 1355-1357

26B Hearing Screening 24 1358-1381




1/07 RECORD LAYOUT

DATA ELEMENT FIELD

LENGTH POSITION

27A Previous Live Births – Now Living 2 1382-1383

27B Previous Live Births – Now Dead 2 1384-1385

27C Date of Last Live Birth 10 1386-1395

27D Other Terminations – Number Before 20 Wks 2 1396-1397

27E Other Terminations – Number After 20 Wks 2 1398-1399

27F Date of Last Other Termination 10 1400-1409

TLB Total Live Births 2 1410-1411

TCB Total Children Ever Born 2 1412-1413

28AA Method of Delivery (Final Delivery Route) 2 1414-1415

28AB How Many Previous Cesareans 1 1416-1416

28AC Fetal Presentation 1 1417-1417

28AD Vaginal Delivery With Forceps Attempted? 1 1418-1418

28AE Vaginal Delivery With Vacuum Attempted? 1 1419-1419

28B Expected Source of Payment for Delivery 2 1420-1421

29 Complications and Procedures of Pregnancy and Concurrent Illnesses

32 1422-1453

30 Complications and Procedures of Labor/Delivery

18 1454-1471

31 Abnormal Conditions and Clinical Procedures Related to the Newborn

20 1472-1491

32 Father/Parent Social Security Number 9 1492-1500

33 Mother/Parent Social Security Number 9 1501-1509

A Maternity Hospital Code 4 1510-1513

B Place of Mother’s Residence Code 3 1514-1516

CT Census Tract 6 1517-1522

FIPS1 FIPS City Place Code (Mother’s Residence) 5 1523-1527

FIPS2 FIPS County Place Code (Mother’s Residence) 3 1528-1530

D Type of Attendant/Certifier Code 1 1531-1531

F Enumeration at Birth 2 1532-1533




1/07 RECORD LAYOUT

DATA ELEMENT FIELD

LENGTH POSITION

CSSN SSN (of Child) 9 1534-1542

APGAR1 APGAR Score at 1 Minute 2 1543-1544

APGAR5 APGAR Score at 5 Minutes 2 1545-1546

APGAR10 APGAR Score at 10 Minutes 2 1547-1548

CIGPN Number of Cigarettes/Day 3 Months Before Pregnancy

2 1549-1550

CIGFN Number of Cigarettes/Day 1st Trimester 2 1551-1552

CIGSN Number of Cigarettes/Day 2nd Trimester 2 1553-1554

CIGTN Number of Cigarettes/Day 3rd Trimester 2 1555-1556

DECP Declaration of Paternity 1 1557-1557

MAR Mother Married? 1 1558-1558

MSTREET Mother’s Mailing Address (Street or PO Box) 50 1559-1608

MCITY Mailing Address City or Town 35 1609-1643

MCOUNTY Mailing Address County 30 1644-1673

MSTATE Mailing Address State 25 1674-1698

MZIP Mailing Address ZIP Code 5 1699-1703

MHT1 Mother’s Height (Feet) 1 1704-1704

MHT2 Mother’s Height (Inches 0-11) 2 1705-1706

MWT1 Mother’s Prepregnancy Weight 3 1707-1709

MWT2 Mother’s Delivery Weight 3 1710-1712

WIC Did Mother Get WIC Food 1 1713-1713

AMEND Amendment Indicator 1 1714-1714

MSCODE State/Foreign Country Code (Mailing Address of Mother)

3 1715-1717

BOX E Planned Place of Birth Code (2006 Births Only)

1 1718-1718

UNUSED Unused Blanks 84 1719-1800


1/07 CERTIFICATE OF LIVE BIRTH

CERTIFICATE OF LIVE BIRTH

A hardcopy of THE CERTIFICATE OF LIVE BIRTH is included in the manual.


1/07 RACE/ETHNICITY AND EDUCATION WORKSHEET

RACE/ ETHNICITY AND EDUCATION WORKSHEET

A hardcopy of RACE/ETHNICITY AND EDUCATION WORKSHEET is included in the manual.


APPENDIX A

1/07 APPENDIX A

Source of Payment Codes Item 25D

PRINCIPAL SOURCE OF PAYMENT FOR PRENATAL CARE

Code 02 Medi-Cal (without CPSP Support Services): The payment category defined

in Title XIX of the Federal Medicare Act (PL 89-971). Note: Item 25D, this code does not apply to Medi-Cal CPS Program. Refer to Code 13.

Code 05 Other government programs: Any form of payment by government agencies,

whether local, state, or federal, except Medi-Cal. Coded here are Indian Health Service and CHAMPUS/TRICARE.

Code 07 Private insurance: Payment covered by any private or commercial insurance

carrier, including Health Maintenance Organizations.

Code 09 Self Pay: Payment directly by the patient, relatives, or friends.

Code 13 Medi-Cal (with CPSP Support Services): This program allows for expanded

Medi-Cal reimbursement for providers in the Comprehensive Perinatal Services (CPS) Program. Providers can receive reimbursement for care given to Medi-Cal eligible women for assessment, reassessment, and intervention services in obstetrics, nutrition, health education, psycho-social, and prenatal vitamin and mineral supplements.

Code 14 Other

Code 00 No prenatal care: This code may only be used if 0 was entered in Item 25B

(Month Prenatal Care Began) and 0 was entered in Item 25C (Number of Prenatal Visits).

Code 99 Unknown: This code may be used if absolutely no information regarding

source of payment for prenatal care is available.


APPENDIX A (continued)

1/07 APPENDIX A

Source of Payment Codes Item 28B

EXPECTED PRINCIPAL SOURCE OF PAYMENT FOR DELIVERY

Code 02 Medi-Cal: The payment category defined in Title XIX of the Federal

Medicare Act (PL 89-971).

Code 05 Other Government Programs: Any form of payment by government agencies,

whether local, state, or federal, except Medi-Cal, Indian Health Service funds, or CHAMPUS/TRICARE.

Code 07 Private insurance: Payment covered by any private or commercial insurance

carrier, including Health Maintenance Organizations.

Code 09 Self Pay: Payment directly by the patient, relatives, or friends.

Code 14 Other

Code 15 Indian Health Services: The federal health program for American Indians and

Alaska Natives.

Code 16 CHAMPUS/TRICARE: The Department of Defense health care program for

members of the uniformed services, their families and survivors, and retired members and their families.

Code 00 Medically unattended birth: This code may only be used if the delivery is

unattended by medical personnel and there is no expected source of payment.

Code 99 Unknown: This code may be used if absolutely no information regarding

source of payment delivery is available.


APPENDIX B

1/07 APPENDIX B

CODES AND ABBREVIATIONS FOR STATE OF BIRTH, RESIDENCE, AND MAILING

STATE (Items 7, 10, 24D, Box B, and MSTATE)

US States and District of Columbia

CODE ABBR.

TEXT FULL TEXT CODE ABBR.

TEXT FULL TEXT

101 AL Alabama 127 MT Montana 102 AK Alaska 128 NE Nebraska 103 AZ Arizona 129 NV Nevada 104 AR Arkansas 130 NH New Hampshire 105 CA California 131 NJ New Jersey 106 CO Colorado 132 NM New Mexico 107 CT Connecticut 133 NY New York 108 DE Delaware 134 NC North Carolina 109 DC District of Columbia 135 ND North Dakota 110 FL Florida 136 OH Ohio 111 GA Georgia 137 OK Oklahoma 112 HI Hawaii 138 OR Oregon 113 ID Idaho 139 PA Pennsylvania 114 IL Illinois 140 RI Rhode Island 115 IN Indiana 141 SC South Carolina 116 IA Iowa 142 SD South Dakota 117 KS Kansas 143 TN Tennessee 118 KY Kentucky 144 TX Texas 119 LA Louisiana 145 UT Utah 120 ME Maine 146 VT Vermont 121 MD Maryland 147 VA Virginia 122 MA Massachusetts 148 WA Washington 123 MI Michigan 149 WV West Virginia 124 MN Minnesota 150 WI Wisconsin 125 MS Mississippi 151 WY Wyoming 126 MO Missouri


APPENDIX B (continued)

Items 7, 10, 24D, Box B, and MSTATE

US Territories, Canadian Provinces, and Foreign Countries MARC ABBR. TEXT FULL TEXT MARC ABBR. TEXT FULL TEXT CODE CODE

AF AFGHANISTAN AFGHANISTAN AA ALBANIA ALBANIA ABC ALBERTA ALBERTA AE ALGERIA ALGERIA AS AMER SAMOA AMERICAN SAMOA AN ANDORRA ANDORRA AO ANGOLA ANGOLA AM ANGUILLA ANGUILLA AY ANTARCTICA ANTARCTICA FS ANTARC FR ANTARCTIQUES

FRANCAISES AQ ANTIGUA ANTIGUA AG ARGENTINA ARGENTINA AI ARMENIA ARMENIA AW ARUBA ARUBA AT AUSTRALIA AUSTRALIA AU AUSTRIA AUSTRIA AJ AZERBAIJAN AZERBAIJAN PO AZORES AZORES BF BAHAMAS BAHAMAS BA BAHRAIN BAHRAIN BG BANGLADESH BANGLADESH BB BARBADOS BARBADOS AQ BARBUDA BARBUDA BW BELARUS BELARUS BE BELGIUM BELGIUM BH BELIZE BELIZE DM BENIN BENIN BM BERMUDA IS BERMUDA ISLANDS BT BHUTAN BHUTAN BO BOLIVIA BOLIVIA BN BOSNIA BOSNIA BS BOTSWANA BOTSWANA BV BOUVET IS BOUVET ISLAND BL BRAZIL BRAZIL

BCC BR COLUMBIA BRITISH COLUMBIA BI BR IN OCEAN BRITISH INDIAN

OCEAN TERRITORY VB BR VIRGN IS BRITISH VIRGIN

ISLANDS BX BRUNEI BRUNEI BU BULGARIA BULGARIA UV BURKINA FSO BURKINA FASO BR BURMA BURMA BD BURUNDI BURUNDI TC CAICOS IS CAICOS ISLANDS CB CAMBODIA CAMBODIA CM CAMEROON CAMEROON CN CANADA CANADA CV CAPE VERDE CAPE VERDE CJ CAYMAN IS CAYMAN ISLANDS CX CEN AFR REP CENTRAL AFRICAN

REPUBLIC CD CHAD CHAD CL CHILE CHILE CC CHINA CHINA XA CHRISTMAS IS CHRISTMAS ISLAND

(INDIAN OCEAN) XB COCOS IS COCOS ISLANDS CK COLOMBIA COLOMBIA CQ COMOROS COMOROS CF CONGO CONGO

(BRAZZAVILLE) CG CONGO REP CONGO REPUBLIC CW COOK IS COOK ISLANDS CR COSTA RICA COSTA RICA IV IVORY COAST COTE D’IVOIRE

Continued on next page 1/07 APPENDIX B





CI CROATIA CROATIA CU CUBA CUBA CY CYPRUS CYPRUS XR CZECH REP CZECH REPUBLIC DK DENMARK DENMARK FT DJIBOUTI DJIBOUTI DQ DOMINICA DOMINICA DR DOMIN DOMINICAN

REPUBLIC EC ECUADOR ECUADOR UA EGYPT EGYPT ES EL SALVADOR EL SALVADOR ENK ENGLAND ENGLAND EG EQUA GUINEA EQUATORIAL

GUINEA EA ERITREA ERITREA ER ESTONIA ESTONIA ET ETHIOPIA ETHIOPIA FK FALKLAND IS FALKLAND ISLANDS FA FAROE IS FAROE ISLANDS FJ FIJI FIJI FI FINLAND FINLAND FR FRANCE FRANCE FG FR GUIANA FRENCH GUIANA FP FR POLYNESIA FRENCH POLYNESIA WF FUTUNA FUTUNA GO GABON GABON GM GAMBIA GAMBIA GZ GAZA STRIP GAZA STRIP GS GEORGIA REP GEORGIA

(REPUBLIC) GW GERMANY GERMANY GH GHANA GHANA

GI GIBRALTAR GIBRALTAR GR GREECE GREECE GL GREENLAND GREENLAND GD GRENADA GRENADA XM GRENADINES GRENADINES GP GUADELOUPE GUADELOUPE GU GUAM GUAM GT GUATEMALA GUATEMALA GV GUINEA GUINEA PG GUINEA-BISS BUINEA-BISSAU GY GUYANA GUYANA HT HAITI HAITI HM HEARD IS HEARD ISLAND BN HERCEGOVINA HERCEGOVINA NA HOLLAND HOLLAND HO HONDURAS HONDURAS HK HONG KONG HONG KONG HU HUNGARY HUNGARY IC ICELAND ICELAND II INDIA INDIA IO INDONESIA INDONESIA IR IRAN IRAN IQ IRAQ IRAW IE IRELAND IRELAND IS ISRAEL ISRAEL IT ITALY ITALY IV IVORY COAST IVORY COAST






JM JAMAICA JAMAICA JA JAPAN JAPAN JI JOHNSTON ATL JOHNSTON ATOLL JO JORDAN JORDAN KZ KAZAKHSTAN KAZAKHSTAN XB KEELING IS KEELING ISLANDS KE KENYA KENYA GB KIRIBATI KIRIBATI KU KUWAIT KUWAIT KG KYRGYZSTAN KYRGYZSTAN LS LAOS LAOS LV LATVIA LATVIA LE LEBANON LEBANON LO LESOTHO LESOTHO LB LIBERIA LIBERIA LY LIBYA LIBYA LH LIECHTENSTN LIECHTENSTEIN LI LITHUANIA LITHUANIA LU LUXEMBOURG LUXEMBOURG MH MACAO MACAO XN MACEDONIA MACEDONIA MG MADAGASCAR MADAGASCAR MW MALAWI MALAWI MY MALAYSIA MALAYSIA XC MALDIVES MALDIVES ML MALI MALI MM MALTA MALTA MBC MANITOBA MANITOBA NW N MARIANAS MARIANA ISLANDS,

NORTHERN XE MARSHALL IS MARSHALL

ISLANDS MQ MARTINIQUE MARTINIQUE MU MAURITANIA MAURITANIA

MF MAURITIUS MAURITIUS OT MAYOTTE MAYOTTE HM MCDONALD IS MCDONALD ISLAND MX MEXICO MEXICO FM MICRONESIA MICRONESIA

(FEDERATED STATES)

XF MIDWAY IS MIDWAY ISLANDS XL MIQUELON MIQUELON MV MOLDOVA MOLDOVA MC MONACO MONACO MP MONGOLIA MONGOLIA YU MONTENEGRO MONTENEGRO MJ MONTSERRAT MONTSERRAT MR MOROCCO MOROCCO MZ MOZAMBIQUE MOZAMBIQUE SX NAMIBIA NAMIBIA NU NAURU NAURU NP NEPAL NEPAL NA NETHERLANDS NETHERLANDS N NETH ANTILES NETHERLANDS

ANTILLES NKC NEW BRUNS NEW BRUNSWICK NL NEW CALEDON NEW CALEDONIA NZ NEW ZEALAND NEW ZEALAND NFC NEWFOUNDLAND NEWFOUNDLAND NQ NICARAGUA NICARAGUA NG NIGER NIGER NR NIGERIA NIGERIA XH NIUE NIUE NX NORFOLK IS NORFOLK ISLAND






KN N KOREA NORTH KOREA NIK N IRELAND NORTHERN

IRELAND NW N MARIANA IS NORTHERN

MARIANA ISLANDS NTC NW TERRITOR NORTHWEST

TERRITORIES NO NORWAY NORWAY NSC NOVA SCOTIA NOVA SCOTIA NUC NUNAVUT NUNAVUT MK OMAN OMAN ONC ONTARIO ONTARIO PK PAKISTAN PAKISTAN PW PALAU PALAU IS PALESTINE PALESTINE PN PANAMA PANAMA PP PAPUA NW GN PAPUA NEW GUINEA PF PARACEL IS PARACEL ISLANDS PY PARAGUAY PARAGUAY PE PERU PERU PH PHILIPPNES PHILIPPINES PC PITCAIRN IS PITCAIRN ISLAND PL POLAND POLAND PO PORTUGAL PORTUGAL PIC PRINCE E IS PRINCE EDWARD

ISLAND SF PRINCIPE PRINCIPE PR PUERTO RICO PUERTO RICO QA QATAR QATAR QUC QUEBEC QUEBEC CH REP CHINA REPUBLIC OF CHINA RE REUNION REUNION RM ROMANIA ROMANIA

RU RUSSIA RUSSIA (FEDERATION)

RW RWANDA RWANDA SS SAHARA SAHARA XJ ST HELENA SAINT HELENA XD ST KITTS SAIND KITTS-NEVIS XK ST LUCIA SAINT LUCIA XL ST PEIRRE SAINT PIERRE XM ST VINCENT SAINT VINCENT AS AM SAMOA SAMOA, AMERICAN WS WEST SAMOA SAMOA, WESTERN SM SAN MARINO SAN MARINO SF SAO TOME SAO TOME SNC SASKATCHEWAN SASKATCHEWAN SU SADI ARABIA SAUDI ARABIA STK SCOTLAND SCOTLAND SG SENEGAL SENEGAL SE SEYCHILLES SEYCHELLES SL SIERA LEONE SIERRA LEONE SI SINGAPORE SINGAPORE XO SLOVAKIA SLOVAKIA XV SLOVENIA SLOVENIA BP SOLOMAN IS SOLOMAN ISLANDS SO SOMALIA SOMALIA SA S AFRICA SOUTH AFRICA XS S GEORGIA SOUTH GEORGIA KO S KOREA SOUTH KOREA XS S SANDWIC IS SOUTH SANDWICH

ISLANDS SP SPAIN SPAIN SH SPAN N AFR SPANISH NORTH

AFRICA XP SPRATLY IS SPRATLY ISLAND






CE SRI LANKA SRI LANKA SJ SUDAN SUDAN SR SURINAM SURINAM SQ SWAZILAND SWAZILAND SW SWEDEN SWEDEN SZ SWITZERLAND SWITZERLAND SY SYRIA SYRIA CH TAIWAN TAIWAN TA TAJIKISTAN TAJIKISTAN TZ TANZANIA TANZANIA FS TERRES AUST TERRES AUSTRALES TH THAILAND THAILAND TR TOBAGO TOBAGO TG TOGO TOGO TL TOKELAU TOKELAU TO TONGA TONGA TR TRINIDAD TRINIDAD TI TUNISIA TUNISIA TU TURKEY TURKEY TK TURKMENISTN TURKMENISTAN TC TURKS IS TURKS ISLANDS TV TUVALU TUVALU UG UGANDA UGANDA UIK UK MISC IS UK MISC ISLANDS UN UKRAINE UKRAINE TS UN ARAB EM UNITED ARAB

EMIRATES UK U.K. KM UNITED KINGDOM US USA UNITED STATES UV UPPER VOLTA UPPER VOLTA UY URUGUAY URUGUAY UP PAC IS:US US MISC PACIFIC

ISLANDS UC CARIB IS:US US MISC. CARIBBEAN

ISLANDS

UZ UZBEKISTAN UZBEKISTAN MN VANUATU VANUATU VC VATICAN CTY VATICAN CITY VE VENEZUELA VENEZUELA VM VIETNAM VIETNAM VB BR VIRGN IS VIRGIN ISLANDS,

BRITISH VI VIRGIN IS VIRGIN ISLANDS, US WK WAKE IS WAKE ISLAND WLK WALES WALES WF WALLIS WALLIS WJ WEST BANK WEST BANK OF THE

JORDAN RIVER SS WEST SAHARA WESTERN SAHARA WS WEST SAMOA WESTERN SAMOA YE YEMEN YEMEN YU YUGOSLVIA YUGOSLAVIA YKC YUKON TER YUKON TERRITORY CG ZAIRE ZAIRE ZA ZAMBIA ZAMBIA RH ZIMBABWE ZIMBABWE XX UNKNOWN UNKNOWN

1/07 APPENDIX B


THIS PAGE FOR NOTES


APPENDIX C

Continued on next page 1/07 APPENDIX C

RACE ORIGIN CODES Used for Father and Mother of Child (Items 18 and 21)

RACE CODES 10-19 WHITE (11-19 not currently used, reserved for future special studies) 20-29 BLACK (21-29 not currently used, reserved for future special studies) 30-39 AMERICAN INDIAN (31-39 not currently used, reserved for future special studies) 40 ASIAN – Unspecified 41 ASIAN – Specified 42 ASIAN – Chinese 43 ASIAN - Japanese 44 ASIAN - Korean 45 ASIAN - Vietnamese 46 ASIAN - Cambodian 47 ASIAN - Thai 48 ASIAN - Loatian 49 ASIAN – Hmong 51 OTHER – Specified 52 INDIAN – (excludes American Indian, Aleut and Eskimo) 53 FILIPINO 54 HAWAIIAN 55 GUAMANIAN 56 SAMOAN 57 ESKIMO 58 ALEUT 59 PACIFIC ISLANDER (excludes Hawaiian, Guamanian, Samoan) 98 WITHHELD 99 UNKNOWN

OTHER (UNSPECIFIED)


APPENDIX C (Items 18, 19, 21, 22) (continued)


Coding Algorithm for Race

1. Selection of up to 3 races are allowed. Code all races in the order listed.

2. If race entry is “Blank”, code race 99 (Unknown or Unreported).

3. If “Unknown” or “Withheld” are entered, no other race should be reported.

4. If race entry is “Other”, code race 51 (Other – Specified).

5. If race entry is “Negro”, “Colored”, “African American” or “Afro-American”, code race 20 (Black).

6. If race entry is “Brown”, refer to Hispanic entry.

a. If Hispanic entry is “Mexican”, “Mexican-American”, “Chicano”, “Puerto Rican”, “Cuban”, “Costa Rican”, “any South American”, “Other Hispanic (Born outside the U.S.)”, or “Other Hispanic (Born in the U.S.)”, then code race 10 (White). If Hispanic entry is “Central American (excluding Costa Ricans)”, code race 51 (Other – Specified).

b. If not Hispanic, refer to birthplace of the parent.

If birthplace is “Mexico”, “Puerto Rico”, “Cuba”, “Costa Rica” or “any South American country”, code race 10 (White). If birthplace is “any Central American country (excluding Costa Rica)”, code race 51 (Other – Specified).

c. If birthplace is “Philippines”, code race 53 (Filipino).

For all other “Brown” not specified above, code race 20 (Black).

7. If the race entry “Yellow”, “Oriental”, “Asian”, “Asiatic” or “Mongolian” is stated in the race field with a specific ethnicity, code race to the specific ethnicity (codes 41-49, 52-59).

8. If the race entry is “Yellow”, “Oriental”, “Asian”, “Asiatic” or “Mongolian” with no

specific ethnicity, refer to birthplace. If birthplace entry is “China”, “Japan”, “Korea”, “Vietnam”, “Cambodia”, “Thailand”, “Laos”, “Philippines”, “Guam”, “Samoa”, “Hawaii”, “India” or “any Pacific Island”, consider the parent as belonging to the race indicated by the birthplace and code appropriately.

If the parent’s birthplace is not specified above, code race 40 (Other Asian).

9. If race entry is “Indian”, and the birthplace is North, South or Central America, code 30 (American Indian).

For all other “Indian”, code race 52 (Asian – Indian).


APPENDIX C (continued)

Other Reported Race Entries with Codes (Items 18 and 21)

ENTRY CODE ENTRY CODE


ABNAKI…………..……….…… 30 ABSENTEE……………….……. 30 ACJACHEMEM……….…..…… 30 ACOMA……………….……..…. 30 AFGHAN………….……………. 10 AFGHANISTAN….………….… 10 AFRICAN…………………….… 20 AFRICAN AMERICAN………... 20 AFRIKANER…………………… 10 AFRO AMERICAN…………….. 20 AGUA CALIENTE……………... 30 AK CHIN……………………….. 30 ALABAMA…………….……….. 30 ALABAQMA…………………… 30 ALASKA NATIVE……………... 30 ALASKAN……………………… 10 ALASKAN INDIAN……………. 30 ALBANIAN…………………….. 10 ALEUT………………………….. 58 ALGERIAN……………………... 10 ALGONKIN…………………….. 30 ALGONQUIAN………………… 30 ALOCONA……………………… 51 ALSEA………………………….. 30 AMERICAN ASIAN……………. 40 AMERICAN…………………….. 10 AMERICAN INDIAN…………... 30 AMISH………………………….. 10 ANGLO…………………………. 10 ANGLO SAXON……………….. 10 APACHE………………………... 30 APALACHEE…………………... 30 AQUA CALIENT………………. 30 ARAB…………………………… 10 ARABIAN………………………. 10 ARABIC………………………… 10 ARAPAHO……………………… 30 ARAPAHOE……………………. 30 ARAWAK………………………. 30

ARGENTINA…………………… 10 ARGENTINIAN………………… 10 ARIKARA………………………. 30 ARMENIAN…………………….. 10 ARUBA…………………………. 10 ARYAN…………………………. 10 ASHANTI………………………. 20 ASIA INDIAN………………….. 52 ASIAN…………………………... * ASIAN AMERICAN……………. 40 ASIAN INDIAN………………… 52 ASIATIC………………………... * ASSINIBOIN…………………… 30 ASSINIBOINE………………….. 30 ASSYRIAN……………………... 10 ATACAPA……………………… 30 ATHABASCAN………………… 30 ATHABASKAN………………… 30 ATHAPASCAN………………… 30 ATHAPASKAN………………… 30 ATSINA………………………… 30 AUSTRALIAN…………………. 10 AUSTRIAN……………………... 10 AZORES………………………… 10 AZTEC………………………….. 30 BAHAMIAN……………………. 51 BALEARIC IS………………….. 10 BANGLADESH………………… 41 BANGLADESHI………………... 41 BANNOCK……………………... 30 BASQUE………………………... 10 BAVARIAN…………………….. 10 BEAR RIVER…………………... 30 BEAVER………………………... 30 BEGRI…………………………... 51 BELIZE…………………………. 51 BELIZEAN……………………… 51






BELIZIAN……………………… 51 BELLA COOLA………………... 30 BENGALI………………………. 52 BEOTHUK……………………… 30 BERBER………………………… 10 BIKINI IS……………………….. 59 BILALIAN……………………… 20 BLACK…………………………. 20 BLACKFEET…………………… 30 BLACKFOOT…………………... 30 BLANC…………………………. 10 BLANCA……………………….. 10 BLANCO……………………….. 10 BLUE LAKE……………….…… 30 BOGOTAN……………………… 10 BOHEMIAN……………………. 51 BOHORA……………………….. 51 BOHRA…………………………. 51 BOLIVIAN……………………… 10 BOOLD PIEGAN……………….. 30 BORICUA………………………. 10 BORNIQUENO………………… 10 BOSNIAN………………………. 10 BRAVA…………………………. 10 BRAVO…………………………. 10 BRAZIL………………………… 10 BRAZILEAN…………………… 10 BRAZILIAN……………………. 10 BRITISH………………………... 10 BRITON………………………… 10 BRITISH HONDURAN………... 51 BROTHERTON……………….... 30 BROWN………………………… * BUENOS AIRES……………….. 10 BULGARIAN…………………… 10 BURMESE……………………… 41 CADDO………………………… 30 CAHUILLA…………………….. 30

CAJUN………………………….. 10 CAKCHIQUEL…………………. 30 CALAPOOYA………………….. 30 CALIFORNIO………………….. 10 CALIF MISSION………………. 30 CALUSA……………………….. 30 CAMBODIA…………….……… 46 CAMBODIAN………….………. 46 CANADIAN…………….……… 10 CANARY IS…………….………. 10 CANTONESE…………………... 42 CAPE VERDE………………….. 20 CARIBBEAN…………………… 51 CARMEL……………………….. 30 CAROLINIAN………………….. 59 CARRIER…………….…………. 30 CASTILIAN…………………….. 10 CATALONIA…………………… 10 CATAWBA……………………... 30 CATTARAUGUAS……………... 30 CATTARAUGUS………………. 30 CAUCASIAN…………………… 10 CAYUGA……………………….. 30 CAYUSE………………………... 30 CELTIC…………………………. 10 CENTRAL AM INDIAN……….. 30 CENTRAL AMERICAN……….. 51 CEYLONESE…………………… 41 CHAAM………………………… 45 CHAKTAW……………………... 30 CHALDEAN……………………... 10 CHAMORRO…………………… 55 CHAMOSSO……………………. 51 CHASTA COSTA………………. 30 CHEHALIS……………………… 30 CHEMEHUEVI…………………. 30 CHEROKEE…………………….. 30 CHETCO………………………... 30






CHEYENNE………………… 30 CHEYENNE SIOUX………... 30 CHICANA…………………… 10 CHICANO…………………… 10 CHICKAHOMINY………….. 30 CHICKASAW………………. 30 CHILEAN…………………… 10 CHILIAN……………………. 10 CHIMARIKO……………….. 30 CHINESE……………………. 42 CHINOOK…………………… 30 CHIPEWYAN……………….. 30 CHIPPEWA…………………. 30 CHIRICAHUA……………… 30 CHITIMACHA……………… 30 CHOCTAW………………….. 30 CHOL………………………... 30 CHONTAL………………….. 30 CHORTI…………………….. 30 CHUCKCHANSI…………… 30 CHUKCHANSI……………… 30 CHUMASH…………………. 30 CHUUKESE………………… 59 CLACKAMUS……………… 30 CLALLAM………………….. 30 CLATSOP…………………… 30 CLEAR LAKE………………. 30 COAST SALISH…………….. 30 COCHIMI……………………. 30 COCHITI…………………….. 30 COCOPA…………………….. 30 COCOPAH…………………... 30 COEUR D’ALENE………….. 30 COLESTRAN……………….. 51 COLOMBIAN………………. 10 COLORED…………………... 20 COLUMBIA………………… 30 COLVILLE………………….. 30 COMANCHE………………... 30

COMOX……………………... 30 CONCOW…………………… 30 CONQUILLE………………... 30 COOS………………………... 30 COSMOPOLITAN…………... 51 COSTA RICAN……………... 10 COSTARRICENSE…………. 10 COUSHATTA……………….. 30 COVELO…………………….. 30 COW CREEK……………….. 30 COWICHAN………………… 30 COWLITZ…………………… 30 COYOTERO………………… 30 CREE………………………… 30 CREEK………………………. 30 CREOLE…………………….. 10 CROAT……………………… 10 CROATIAN…………………. 10 CROW……………………….. 30 CROW CREEK……………… 30 CRUCIAN…………………… 10 CUBAN……………………… 10 CZECHOSLOVAKIAN……... 10 DAKOTA……………………. 30 DANISH……………………... 10 DECLINES TO STATE……... 98 DELAWARE………………… 30 DENMARK…………………. 10 DIEGENO…………………… 30 DIEGUENO…………………. 30 DIGGER…………………….. 30 DOG RIB……………………. 30 DOMINICAN……………….. 20 DOMINICANO……………… 20 DUCKWATER……………… 30 DUTCH……………………… 10 DUTCH EAST INDIES……... 41 DUTCH INDONESIAN…….. 41






EAST INDIAN……………… 52 EAST INDIES………………. 41 EASTERN INDIAN………… 52 EBIAN………………………. 10 ECUADORIAN……………… 10 EGYPTIAN…………………. 10 EL SALVADORIAN……….. 51 ENGLISH…………………… 10 ENIWETOK IS……………… 59 ERITREA…………………… 20 ERITREAN…………………. 20 ESKIMO…………………….. 57 ESPANA…………………….. 10 ESPANOL…………………… 10 ESTONIAN………………….. 10 ETHIOPIA…………………… 20 ETHIOPIAN………………… 20 EUCHI………………………. 30 EURASIAN…………………. 40 EUROPEAN………………… 10 EYAK……………………….. 30 FALKLAND IS……………… 10 FAR YEN……………………. 42 FAR YUEN………………….. 42 FERNANDO PO…………….. 10 FIJIAN………………………. 59 FILIPINO…………………… 53 FINNISH……………………. 10 FLATHEAD………………… 30 FORMOSAN………………… 42 FORT HALL………………… 30 FOX………………………….. 30 FRENCH…………………….. 10 FRENCH CANADIAN…….... 10 FRENCH GUIANA.…..…….. 30 FRENCH INDIAN..…………. 10 FUJI INDIAN……………….. 59

GABRIELENO……………… 30 GALAPAGOS IS……………. 10 GALICE CREEK……………. 30 GANESE…………………….. 10 GANESEAN………………… 10 GAYHEAD………………….. 30 GEORGIAN…………………. 10 GERMAN…………………… 10 GHANAIAN………………… 20 GILBERTESE………………. 59 GOANESE…………………... 52 GOSHUTE…………………... 30 GOSIUTE…………………… 30 GRAPALENO………………. 30 GREEK……………………… 10 GROS VENTRE…………….. 30 GUAMANIAN……………… 55 GUAMESE………………….. 55 GUAMIAN………………….. 55 GUATEMALA……………… 51 GUATEMALAN……………. 51 GUYAN……………………… 51 GUYANAN…………………. 51 GUYANESE………………… 51 GYPSY……………………… 10 HAIDA……………………… 30 HAITIAN…………………… 20 HALIWA……………………. 30 HAMITIC…………………… 20 HAN………………………… 30 HARE……………………….. 30 HAT CREEK………………... 30 HAVASUPAI……………….. 30 HAWAIIAN…………………. 54 HAWASUPAI……………….. 30 HEBREW……………………. 10 HIDATSA…………………… 30






HINDU………………………. 52 HISPANIC…………………… 10 HISPANO…………………… 10 HMONG……………………... 49 HOH…………………………. 30 HONDURAN………………... 51 HONG KONG……………….. 42 HOOPA……………………… 30 HOPI………………………… 30 HOUMA……………………... 30 HOWONQUET……………… 30 HUALAPAI…………………. 30 HUASTEC…………………… 30 HUMBOLDT BAY………….. 30 HUNGARIAN………………. 10 HUPA………………………... 30 HURON……………………… 30 IBERIAN…………………….. 10 ICELANDIC………………… 10 ILLINOIS……………………. 30 INCA………………………… 30 INDIAN ASIAN…………….. 52 INDIAN……………………… * INDONESIA………………… 41 INDONESIAN………………. 41 INGALIK……………………. 30 INUIT………………………... 57 IOWA………………………... 30 IPAI TPAI…………………… 30 IRANIAN…….……………… 10 IRAQI………………………... 10 IRAQUI……………………… 10 IRISH………………………… 10 IROQUOIS…………………... 30 ISLAMIC……………………. 10 ISLETA……………………… 30 ISRAELI…………………….. 10 ISRAELIAN………………… 10

ISRAELITE………………….. 10 ITALIAN…………………….. 10 JACK WHITE……………….. 51 JACKSON WHITE………….. 51 JAMAICAN…………………. 20 JAPANESE………………….. 43 JAVA………………………… 41 JEMEZ………………………. 30 JERUSALEM………………... 10 JEW………………………….. 10 JEWISH……………………… 10 JICARILLA………………….. 30 JORDAN…………………….. 10 JORDANIAN………………... 10 JOSHUA…………………….. 30 JUAHSHAW………………… 30 JUANENO…………………… 30 KAIBAH…………………….. 30 KALISPEL…………………... 30 KANOSH……………………. 30 KANSA……………………… 30 KARANKAWA……………... 30 KAROK……………………… 30 KARUK……………………… 30 KASHAYA POMO………….. 30 KASKA……………………… 30 KAW………………………… 30 KAWAI……………………… 30 KENYAN……………………. 20 KERESAN PUEBLO………... 30 KERN RIVER……………….. 30 KHMER……….…………….. 48 KHMU..……………………… 46 KICHAI……………………… 30 KICKAPOO…………………. 30






KIOWA……………………… 30 KIOWA APACHE…………... 30 KITAMAT…………………… 30 KLAMATH………………….. 30 KLIKITAT…………………... 30 KOASATI…………………… 30 KONA……………………….. 30 KOOTENAI…………………. 30 KOREAN……………………. 44 KOSOVAR………………….. 10 KOSOVARIAN……………… 10 KOSRAEAN………………… 59 KURDISH…………………… 10 KUSA………………………... 30 KUTCHIN…………………… 30 KUWAITIAN………………... 10 KWAJALEIN IS…………….. 59 KWAKIUTL………………… 30 LA RAZA…………………… 10 LAC COURTE……………… 30 LADINA…………………….. 10 LADINO…………………….. 10 LAGUNA…………………… 30 LAHU………………………... 48 LAKMUIT…………………… 30 LAKOTA……………………. 30 LAKOTA SIOUX…………… 30 LAOTIAN…………………… 48 LATIN………………………. 10 LATIN AMERICAN………… 10 LATINA……………………... 10 LATINO……………………... 10 LATVIAN…………………… 10 LEBANESE…………………. 10 LENCA……………………… 30 LIBERIAN…………………... 20 LIBYAN……………………... 10 LIPAN APACHE……………. 30

LITHUANIAN………………. 10 LOWER BRULE…………….. 30 LUISENO…………………… 30 LUMBEE……………………. 30 LUMMI……………………… 30 MACANESE………………… 42 MACAU……………………... 42 MACEDONIAN……………... 10 MAHICAN…………………... 30 MAIDU……………………… 30 MAJORCA………………….. 10 MAKAH…………………….. 30 MAL………………………… 51 MALADA…………………… 51 MALAWIAN……………….. 20 MALAYAN………………… 41 MALAYSIA………………… 41 MALAYSIAN………………. 41 MALECITE…………………. 30 MALISEET…………………. 30 MALLORQUIN……………... 10 MALTESE…………………… 10 MANAGUA………………… 51 MANATUAN……………….. 51 MANDAN…………………… 30 MAORI……………………… 59 MARIANA IS……………….. 59 MARICOPA…………………. 30 MARSHALLESE…….……… 59 MARSHENESE……………... 10 MARY’S RIVER……………. 30 MASHPEE…..………………. 30 MATTAPONI……………….. 30 MAURITIAN………………... 10 MAYA……………………….. 30 MAYAN……………………... 30 MAYO……………….………. 30






MDEWAKANTON…………. 30 MEDITERRANEAN………… 10 MELANESIAN……………… 59 MENOMINEE………………. 30 MENOMINI………………… 30 MEQUENDODON………….. 30 MESCALERO………………. 30 MESTIZA…………………… 51 MESITZO…………………… 51 MESTIZO INCA……………. 51 METIS.……………………… 30 MEWA………………………. 30 MEWUK…………………….. 30 MEXICAN AMERICAN……. 10 MEXICAN…………………... 10 MEXICAN INDIAN………… 30 MIAMI…………………….… 30 MICCOSUKEE……………… 30 MICMAC……………………. 30 MICRONESIAN…………….. 59 MID EASTERN……………... 10 MIEN………………………… 41 MISSION BANDS…………... 30 MISSION INDIAN..………… 30 MISSOURI…………………... 30 MIWOK……………………… 30 MIXE………………………… 30 MIXED……………………… 51 MIXTEC…………………….. 30 MODOC……………………... 30 MOHAMMEDAN…………… 10 MOHAVE…………………… 30 MOHAWK…………………... 30 MOHEGAN………………….. 30 MOJAVE…………………….. 30 MOLALA……………………. 30 MOLDOVIAN………………. 10 MONACHI…………………... 30 MONGOLIAN………………. *

MONGREL………………….. 51 MONO………………………. 30 MONROVIAN……………… 20 MONTAGNAIS……………... 30 MONTAUK…………………. 30 MONTENEGRIN…………… 10 MOOR………………………. 51 MOORISH………………….. 51 MORENA…………………… 30 MORENO…………………… 30 MOROCCAN……………….. 10 MOSLEM…………………… 10 MOSOTHO…………………. 51 MUCKLESHOOT…………… 30 MUGANDAN………………. 20 MULATTO…………………. 20 MUNSEE……………………. 30 MUSCOGEE………………… 30 MUSKOGEAN……………… 30 MUSLIM……………………. 10 MYWUK……………………. 30 NAMBE……………………… 30 NAMSEMOND……………… 30 NANTICOKE……………….. 30 NARRAGANSETT…………. 30 NASKAPI…………………… 30 NASSAU……………………. 20 NATCHEZ……………….….. 30 NATIVE AMERICAN……… 30 NAVAHO…………………… 30 NAVAJO……………………. 30 NEGRO……………………… 20 NAPALESE…………………. 41 NETHERLANDS…………… 10






NEW HEBRIDES IS…………. 59 NEW ZEALAND…………….. 10 NEZPERCE…………………… 30 NIANTIC……………………… 30 NICARAGUA………………… 51 NICARAGUAN………………. 51 NIGERIAN…………………… 20 NIPMUCK……………………. 30 NIPON………………………… 43 NIPPONESE………………….. 43 NISQUALLY…………………. 30 NOMELAKI………………….. 30 NOOKSAK…………………… 30 NOOTKA……………………... 30 NORDIC……………………… 10 N AMERICAN INDIAN……… 30 NORTH PAIUTE……………... 30 NORWEGIAN………………... 10 NOT GIVEN………………….. 98 NOT STATED………………... 98 NUBIAN……………………… 20 NUMSOOSE………………….. 30 OAXACAN..…………………. 30 OAXCA…….………………… 30 OCCIDENTAL……………….. 10 OCTAROON…………………. 20 OGALIA……………………… 30 OGLALA SIOUX…………….. 30 OHLONE……………………… 30 OINSHI……………………….. 30 OJIBWAY…………………….. 30 OKANOGAN…………………. 30 OKINAWAN………………….. 43 OLMEC……………………….. 30 OMAHA………………………. 30 ONEIDA……………………… 30 ONONDAGA…………………. 30 OPATA……………………….. 30

OPATO……………………….. 30 ORIENTAL…………………… * OSAGE……………………….. 30 OTHER……………………….. 51 OTO…………………………… 30 OTOE…………………………. 30 OTOMI……………………….. 30 OTTAWA…………………….. 30 OZETTE……………………… 30 PACIFIC IS…………………… 59 PAIUTE…………………….…. 30 PAKISTAN…………………… 41 PAKISTANI……………….….. 41 PALAUAN……………………. 59 PALAWAN…………………… 53 PALESTINE………………….. 10 PALESTINIAN………………. 10 PALOUSE…………………….. 30 PAMUNKEY…………………. 30 PANAMA…………………….. 51 PANAMANIAN……………… 51 PANAMENO…………………. 51 PANAMERICAN…………….. 10 PANAMINT………………….. 30 PAPAGO……………………… 30 PAPUA NEW GUINEAN……. 59 PARAGUAYAN……………… 10 PARSI………………………… 10 PASSAMAQUODDY………… 30 PATWIN……………………… 30 PAWNEE……………………... 30






PEN D’OREILLE…………… 30 PENNACOOK………………. 30 PENOBSCOT……………….. 30 PENUTIAN…………………. 30 PEORIA……………………… 30 PEQUOT…………………….. 30 PERICUE……………………. 30 PERSIAN……………………. 10 PERUVIAN…………………. 10 PHILIPINO………………….. 53 PHOENICIAN………………. 51 PICURIS…………………….. 30 PIMA………………………… 30 PIME………………………… 30 PIT RIVER………………….. 30 PLAINS CREE………………. 30 PLAINS OBJIBAY………….. 30 POHNPEIAN………………... 59 POJOAQUE…………………. 30 POLISH……………………… 10 POLYNESIAN……………… 59 POMO……………………….. 30 POMOC……………………… 30 PONAPEAN………………… 59 PONCA……………………… 30 POOSEPATUCK……………. 30 PORTUGUESE……………… 10 POTAWATOME……………. 30 POTAWATOMEE…………... 30 POTAWATOMI…………….. 30 POTOMAC………………….. 30 POTTAWATTIMI…………... 30 POWHATAN………………... 30 PUEBLO…………………….. 30 PUERTO RICAN……………. 10 PUNJAB……………………... 52 PUNJABI……………………. 52 PUYALLUP………………… 30

QUADROON………………... 20 QUAPAW…………………… 30 QUECHAN………………….. 30 QUECHUA………………….. 30 QUILEUTE………………….. 30 QUINAIELT………………… 30 QUINAULT…………………. 30 RAPPAHANNOCK…………. 30 RED……………………….…. 30 REDWOOD CREEK………... 30 REFUSED…………………… 98 RESIGHINI………………….. 30 RHODESIAN………………... 20 ROGUE RIVER……………... 30 ROMANIAN………………… 10 ROSEBUD SIOUX………….. 30 ROTANESE…………………. 59 ROUND VALLEY…………... 30 RUSSIAN……………………. 10 RYUKYAN………………….. 43 SAC…………………….……. 30 SAC AND FOX……………… 30 SAC FOX………..…….…….. 30 SACON……………………… 10 SAGINAW…………….…….. 30 SAIGON……………….…….. 45 SAIPANESE………………… 59 SALISH……………………… 30 SALVADORIAN…………… 51 SAMOAN…………………… 56 SAN FELIPE………………… 30 SAN ILDEFONSO…….…….. 30 SAN JUAN………….……….. 30 SAN LORENZO…………….. 30 SAN LUIS OBISPO…………. 30






SAN LUISENO……………… 30 SAN SALVADOR…………... 51 SANDIA……………………... 30 SANPOIL……………………. 30 SANPOIL NESPELEM……... 30 SANT’ANA…………………. 30 SANTA BARBARA………… 30 SANTA CLARA……………. 30 SANTA YNEZ……………… 30 SANTEE…………………….. 30 SANTEE SIOUX……………. 30 SANTIAGAN……………….. 10 SANTIAGO…………………. 10 SANTIAM…………………… 30 SANTO DOMINGAN………. 20 SAPONI……………………... 30 SARCEE…………………….. 30 SAUDI ARABIAN………….. 10 SAUK………………………... 30 SAUK AND FOX…………… 30 SAXON……………………… 10 SAXONY……………………. 10 SCANDINAVIAN…………... 10 SCATICOOK……………….. 30 SCOTCH…………………….. 10 SCOTTISH………………….. 10 SEKANE…………………….. 30 SELAWIK…………………… 30 SEMANOLE………………… 30 SEMINOLE………………….. 30 SEMITIC…………………….. 10 SENECA…………………….. 30 SEOUL………………………. 44 SERBIAN…………………… 10 SERI…………………………. 30 SERRANO…………………... 30 SERVIAN…………………… 10 SEYCHELLOISE……………. 20 SHANGHAI…………………. 42

SHASTA…………………….. 30 SHAWNEE………………….. 30 SHINNECOCK……………… 30 SHINNECOK……………….. 30 SHIVWITS………………….. 30 SHOSHONE………………… 30 SHUSWAP…..……………… 30 SHUSWAPES……………… 30 SIAMESE…………………… 47 SIAMSH AMERICAN…….... 51 SICILIAN…………………… 10 SIKH………………………… 52 SIKHISM……………………. 52 SILETZ………………………. 30 SINGAPORIAN……………... 41 SINGHALESE………………. 41 SINHALESE………………… 41 SINO BURMAN…………….. 42 SIOUANS…………………… 30 SIOUX……………………….. 30 SISSETON…………………... 30 SIUSLAW…………………… 30 SKAGIT SUIATTLE………... 30 SKOKOMISH……………….. 30 SLAVE………………………. 30 SLAVIC……………………… 10 SLOVAKIAN………………... 10 SLOVENIAN………………... 10 SMITH RIVER……………… 30 SNAKE……………………… 30 SNOHOMISH……………….. 30 SNOQUALMI……………….. 30 SOANISH……………………. 99 SOBONA……………………. 30 SOLOMON IS……………….. 59






SOMALIAN…………………. 20 SONGISH PAUITE…………. 30 SOUTH AFRICAN………….. 10 SOUTH AMERICAN……….. 10 S AMERICAN INDIAN…….. 30 SOUTH PAIUTE……………. 30 SPANIARD………………….. 10 SPANISH……………………. 10 SPOKANE…………………… 30 SQUAXIN…………………… 30 SRI LANKAN……………….. 41 STOCKBRIDGE…………….. 30 SUDANESE…………………. 20 SUMO MOSQUITO………… 30 SUNNI……………………….. 10 SUQUAMISH……………….. 30 SURINAM…………………… 10 SURINAME…………………. 10 SUSQUEHANNOC…………. 30 SWEDISH…………………… 10 SWINOMISH………………... 30 SWISS……………………….. 10 SYRIAN……………………... 10 TAGALOG…………………... 53 TAHITIAN…………………... 59 TAIMSKIN………………….. 30 TAIWAN……………………. 42 TAIWANESE……………….. 42 TALAWA…………………… 30 TAMIL CEYLONESE………. 41 TAMIL MALAYAN………… 41 TANANA……………………. 30 TANOAN PUEBLOS……….. 30 TANZANIAN……………….. 20 TAOS………………………… 30 TARAHUMARE……………. 30 TARAHUMAREX…………... 30 TARASCAN………………… 30

TARAWA IS………………… 59 TAWAKONI………………… 30 TEHRAN…………………….. 10 TEJON……………………….. 30 TENINO……………………... 30 TESUQUE…………………… 30 TETON………………………. 30 TETON SIOUX……………… 30 TEUTONIC………………….. 10 TEWA……………………….. 30 THAI………………………… 47 THLINGET………………….. 30 THLINGIT…………………... 30 TIBETAN……………………. 41 TILLAMOOK……………….. 30 TIMUCUA…………………... 30 TINIAN IS…………………… 59 TIQUA……………………….. 30 TLINGIT…………………….. 30 TOBAGO……………………. 20 TOKELAUAN………………. 59 TOLOWA…………………… 30 TOLTEC…………………….. 30 TONAWANDA……………… 30 TONGAN……………………. 59 TONKAWA…………………. 30 TONTO APACHE…………... 30 TOPINISH…………………… 30 TOTONAC…………………... 30 TRIGUENO………………….. 51 TRINIDADIAN……………… 20 TRUK………………………... 59 TRUKESE…………………… 59 TSIMPSHIAN……………….. 30 TSIMSHIAN………………… 30 TULALIP……………………. 30






TULE RIVER INDIAN……… 30 TUNICA……………………... 30 TUNISIAN…………………... 10 TURK………………………... 10 TURKISH…………………… 10 TUSCARORA………………. 30 TUTUTNI…………………… 30 UBONTILIAN……………..... 41 UGANDAN………………….. 20 UKRAINIAN……………...… 10 UKRANIAN………………… 10 ULITHIAN…………………... 51 UMATILLA…………………. 30 UMPQUA…………………… 30 UNKNOWN………………… 99 UPPER CHINOOK…………. 30 URUGUAYAN……………… 10 UTE………………………….. 30 VALENCIAN……..………… 10 VENEZUELAN……………... 10 VERA CRUZ………………... 10 VIETNAM…………………… 45 VIETNAMESE……………… 45 WACA…………………….…. 30 WACO………………….……. 30 WAHPETON………………… 30 WAICURI…………………… 30 WAILACKI…………………. 30 WAILAKI…………………… 30 WALAPAI…………………… 30 WALLA WALLA…………… 30 WAMPANOAG……………... 30 WAPATO……………………. 30 WAPPINGER……………….. 30 WARM SPRINGS…………… 30 WASCO……………………… 30

WASHO……………………... 30 WASHOE……………………. 30 WASP………………………... 10 WELSH……………………… 10 WEOTT……………………… 30 WEST INDIAN……………… 20 WESTERN SHOSHONE……. 30 WESTERN APACHE……….. 30 WESTERN INDIAN………… 20 WHITE………………….…… 10 WICHITA……………………. 30 WIKCHAMNI……………….. 30 WILKUT…………………….. 30 WIND RIVER……………….. 30 WINNEBAGO………………. 30 WINTU…………………….… 30 WINTUN………………….…. 30 WISHRAM……………….….. 30 WITHHELD…………………. 98 WYANDOTTE……………… 30 WYLACKI…………………... 30 XICAQUE…………………… 30 XINDU………………………. 52 YAHI………………………… 30 YAHOOSKIN……………….. 30 YAKIMA…………………….. 30 YAMASEE…………………... 30 YAMEL……………………… 30 YANA……………………….. 30 YANKTON………………….. 30 YANKTON SIOUX…………. 30




ENTRY CODE


YANKTONNAIS……………. 30 YAPANES………………….... 59 YAPESE……………………... 59 YAQUI………………………. 30 YAQUINA…………………... 30 YAVAPAI…………………… 30 YAWILMANI……………….. 30 YELLOW……………………. * YELLOW KNIFE…………… 30 YEMAN……………………... 10 YEMEN……………………… 10 YEMENITE…………………. 10 YERINGTON………………... 30 YOCA……………………….. 30 YOKUT……………………… 30 YOKUTS…………………….. 30 YOMBA SHOSONE………… 30 YORUBA…………………… 20 YUCHI………………………. 30 YUGOSLAVIAN…………… 10 YUKI………………………… 30 YUMA………………………. 30 YUROK……………………… 30 ZACATEC…………………... 30 ZAMBIA…………………….. 20 ZAPOTEC…………………… 30 ZIA…………………………... 30 ZOQUE……………………… 30 ZOROASTRIAN……………. 10 ZUNI………………………… 30

* SEE RACE CODING INSTRUCTIONS FOR APPROPRIATE CODE.



Hispanic Origin Codes (Items 19 and 22) CODE DESCRIPTION1 Not Hispanic 2 Mexican/Mexican-American/Chicano 3 Puerto Rican 4 Cuban 5 Central/South American 6 Other Hispanic (Born outside the U.S.) 8 Other Hispanic (Born in the U.S.) 9 Unknown or Unreported 1. If race field is reported with a non-Hispanic entry (i.e., White, Black, etc.) and “No” is

reported in the Hispanic field, then assign code 1 (Not Hispanic). 2. If the Hispanic field is “Blank” and the race field is “Blank”, assign code 9 (Unknown or

Unreported). 3. If a non-specific Hispanic entry is reported in the Hispanic field, but entries in the race

field are reported as “Mexican”, “Cuban”, “Puerto Rican”, or any other Hispanic entry that is listed in Appendix C, “Other Reported Hispanic Entries with Codes”, assign the appropriate code of 2-6 or 8.

4. If a non-specific Hispanic entry is reported in the Hispanic field, and there are no

Hispanic entries in the race field, as identified in instruction 3 above, refer to birthplace. If entries in the birthplace field are reported as “Mexican”, “Cuban”, “Puerto Rican”, or any other Hispanic entry that is listed in Appendix C. “Other Reported Hispanic Entries with Codes”, assign the appropriate code 2-6 or 8.

5. If more than one Hispanic entry is reported in the Hispanic field, code first-listed entry

(i.e., Puerto Rican/Cuban, code 3 (Puerto Rican)). 6. If Hispanic field is “Blank” and entries in the race field are reported as “Mexican”,

“Cuban”, “Puerto Rican” or any other Hispanic entry, assign the appropriate code of 2-6 or 8.

7. If Hispanic field is “Blank” and there are no Hispanic entries in the race field, as

identified in instruction 8 above, refer to birthplace. If entries in the birthplace field are reported as “Mexican”, “Cuban”, “Puerto Rican”, or any other Hispanic entry that is listed in Appendix C, “Other Reported Hispanic Entries with codes”, assign the appropriate code 2-6 or 8.




Other Reported Hispanic Entries with Codes (Items 19 and 22) ENTRY CODE ENTRY CODE ARGENTINA 5 ARGENTINIAN 5 ARGENTINO 5 BALEARIC ISLAND * BASQUE * BELIZE 5 BELIZEAN 5 BELIZIAN 5 BOGOTA 5 BOGOTAN 5 BOLIVIA 5 BOLIVIAN 5 BOLIVIANO 5 BORICUA * BORNINQUENO * BRAZIL 5 BRAZILEAN 5 BRAZILIANO 5 BUENOS AIRES 5 CALIFORNIO 8 CANARY ISLANDS * CASTILIAN * CATALONIA * CENTRAL AMERICAN 5 CENTROAMERICANO 5 CHICANA 2 CHICANA-CHICANO 2 CHICANO 2 CHILE 5 CHILEAN 5 CHILENO 5 COLOMBIA 5 COLOMBIAN 5 COLOMBIANO 5 COSTA RICA 5 COAST RICAN 5 COSTARRICENSE 5

CUBA 4 CUBAN 4 CUBANO 4 DOMINICAN REPUBLIC 5 DOMINICAN 5 DOMINICANO 5 ECUADOR 5 ECUADORAN 5 ECUADORIAN 5 ECUATORIANO 5 EL SALVADOR 5 EL SALVADORIAN 5 ESPANA * ESPANOL * FALKLAND ISLANDS 5 FERNANDO PO * GALAPAGOS ISLANDS 5 GANESE 5 GANESEAN 5 GT 5 GUATEMALA 5 GUATEMALAN 5 GUATEMAL TECO 5 GUYAN 5 GUYANAN 5 GUYANESE 5 HISPANO * HONDURAN 5 HONDURENO 5 IBERIA * IBERIAN * IBERO *




Other Reported Hispanic Entries with Codes (Items 19 and 22) ENTRY CODE ENTRY CODE JAMAICA 5JAMAICAN 5 LA RAZA *LADINA 5LADINO 5LATIN *LATIN AMERICAN *LATINA *LATINO * MAJORCA *MALLORCA *MALLORQUIN *MANAGUA 5MANAGUAN 5MEXICAN 2MEXICAN AMERICAN 2MEXICANO 2MEXICO 2 NICARAGUA 5NICARAGUAN 5NICARAGUAENSE 5NOT STATED 9 OTHER *OTHER/HISPANIC * PANAMA 5PANAMANIAN 5PANAMENO 5PARAGUAY 5PARAGUAYAN 5PARAGUAYO 5PERU 5PERUANO 5PERUVIAN 5PUERTO RICAN 3

PUERTO RICO 3 PUERTORRIQUENO 3 REFUSED 9 REFUSED TO STATE 9 SALVADORENO 5 SAN SALVADOR 5 SANTIAGAN 5 SANTIAGO 5 SANTO DOMINGO 5 SANTO DOMINGAN 5 SOUTH AMERICAN 5 SPAIN * SPANIARD * SPANISH * SPANISH/HISPANIC * SURINAM 5 SURINAME 5 UNKNOWN 9 UNREPORTED 9 URUGUAY 5 URUGUAYAN 5 URUGUAYO 5 VALENCIAN * VENEZOLANO 5 VENEZUELA 5 VENEZUELAN 5 VERA CRUZ 2 WEST INDIES 5 WITHHELD 9

* NON-SPECIFIC HISPANIC ENTRY – SEE HISPANIC ORIGIN CODING INSTRUCTIONS FOR APPROPRIATE CODE.

1/07 APPENDIX C


APPENDIX D

MEDICAL INFORMATION CODES

COMPLICATIONS AND PROCEDURES OF PREGNANCY AND CONCURRENT ILLNESSES, (ITEM 29)

DIABETES

Code 09 – Prepregnancy (Diagnosis prior to this pregnancy)

Code 31 – Gestational (Diagnosis in this pregnancy) HYPERTENSION

Code 03 – Prepregnancy (Chronic)

Code 01 – Gestational (PIH, Preeclampsia)

Code 02 – Eclampsia OTHER COMPLICATIONS/PREGNANCIES

Code 32 – Large fibroids

Code 33 – Asthma

Code 34 – Multiple pregnancy (more than 1 fetus this pregnancy)

Code 35 – Intrauterine growth restricted birth this pregnancy

Code 23 – Previous preterm birth (<37 weeks gestation) Code 36 – Other previous poor pregnancy outcomes (Includes perinatal death, small-for-

gestational age/intrauterine growth restricted birth, large for gestational age, etc.) OBSTETRIC PROCEDURES

Code 24 – Cervical cerclage

Code 28 – Tocolysis

Code 37 – External cephalic version – Successful

Code 38 – External cephalic version – Failed

Code 39 – Consultation with specialist for high risk obstetric services PREGNANCY RESULTED FROM INFERTILITY TREATMENT

Code 40 – Fertility-enhancing drugs, artificial insemination or intrauterine insemination Code 41 – Assisted reproductive technology (e.g., in vitro fertilization (IVF), gamete

intrafallopian transfer (GIFT)

Continued on next page 1/07 APPENDIX D


APPENDIX D (continued)


COMPLICATIONS AND PROCEDURES OF PREGNANCY AND CONCURRENT ILLNESSES, (ITEM 29) (Continued)

INFECTIONS PRESENT AND/OR TREATED DURING THIS PREGNANCY

Code 42 – Chlamydia

Code 43 – Gonorrhea

Code 44 – Group B streptococcus

Code 18 – Hepatitis B (acute infection or carrier)

Code 45 – Hepatitis C

Code 16 – Herpes simplex virus (HSV)

Code 46 – Syphilis PRENATAL SCREENING DONE FOR INFECTIOUS DISEASES

Code 51 – Chlamydia

Code 52 – Gonorrhea

Code 53 – Group B streptococcal infection

Code 54 – Hepatitis B

Code 55 – Human immunodeficiency virus (offered)

Code 56 – Syphilis NONE OR OTHER COMPLICATIONS/PROCEDURES NOT LISTED

Code 00 – None

Code 30 – Other Pregnancy Complications/Procedures not Listed





COMPLICATIONS AND PROCEDURES OF LABOR AND DELIVERY (ITEM 30) ONSET OF LABOR

Code 10 – Premature rupture of membranes ( ≥ 12 hours)

Code 07 – Precipitous labor (< 3 hours)

Code 08 – Prolonged labor ( ≥ 20 hours) CHARACTERISTICS OF LABOR AND DELIVERY

Code 11 – Induction of labor

Code 12 – Augmentation of labor

Code 32 – Non-vertex presentation Code 33 – Steroids (glucocorticoids) for fetal lung maturation received by the mother prior

to delivery

Code 34 – Antibiotics received by the mother during labor Code 35 – Clinical chorioamnionitis diagnosed during labor or maternal temperature ≥ 38º C

(100.4º F)

Code 19 – Moderate/heavy meconium staining of the amniotic fluid Code 36 – Fetal intolerance of labor such that one or more of the following actions was

taken: in-utero resuscitative measures, further fetal assessment, or operative delivery

Code 37 – Epidural or spinal anesthesia during labor Code 25 – Mother transferred for delivery from another facility for maternal medical or fetal

indications COMPLICATIONS OF PLACENTA, CORD, AND MEMBRANES

Code 38 – Rupture of membranes prior to onset of labor

Code 13 – Abruptio placenta

Code 39 – Placental insufficiency

Code 20 – Prolapsed cord

Code 17 – Chorioamnionitis





COMPLICATIONS AND PROCEDURES OF LABOR AND DELIVERY (ITEM 30) (Continued)

MATERNAL MORBIDITY (Continued)

Code 24 – Maternal blood transfusion

Code 40 – Third or fourth degree perineal laceration

Code 41 – Ruptured uterus

Code 42 – Unplanned hysterectomy

Code 43 – Admission to ICU

Code 44 – Unplanned operating room procedure following delivery NONE OR OTHER COMPLICATIONS/PROCEDURES NOT LISTED

Code 00 – None

Code 31 – Other Labor/Delivery Complications /Procedures not Listed





ABNORMAL CONDITIONS AND CLINICAL PROCEDURES RELATING TO THE NEWBORN (ITEM 31)

CONGENITAL ANOMALIES

Code 01 – Anencephaly

Code 02 – Meningomyelocele/Spina bifida

Code 76 – Cyanotic congenital heart disease

Code 77 – Congenital diaphragmatic hernia

Code 78 – Omphalocele

Code 79 – Gastroschisis Code 80 – Limb reduction defect (excluding congenital amputation and dwarfing

syndromes)

Code 28 – Cleft palate alone

Code 29 – Cleft lip alone

Code 30 – Cleft palate with cleft lip

Code 57 – Down’s Syndrome – Karyotype confirmed

Code 81 – Down’s Syndrome – Karyotype pending

Code 82 – Suspected chromosomal disorder – Karyotype confirmed

Code 83 – Suspected chromosomal disorder – Karyotype pending

Code 35 – Hypospadias

Code 88 – Aortic stenosis

Code 89 – Pulmonary stenosis

Code 90 – Atresia

Code 62 – Additional and unspecified congenital anomalies not listed above ABNORMAL CONDITIONS Code 66 – Significant birth injury (skeletal fracture(s), peripheral nerve injury, and/or soft

tissue/solid organ hemorrhage which requires intervention)





ABNORMAL CONDITIONS AND CLINICAL PROCEDURES RELATING TO THE NEWBORN (ITEM 31) (Continued)

ADDITIONAL ABNORMAL CONDITIONS/PROCEDURES

Code 71 – Assisted ventilation required immediately following delivery

Code 85 – Assisted ventilation required for more than 6 hours

Code 73 – NICU admission

Code 86 – Newborn given surfactant replacement therapy

Code 87 – Antibiotics received by the newborn for suspected neonatal sepsis

Code 70 – Seizure or serious neurological dysfunction

Code 74 – Newborn transferred to another facility within 24 hours of delivery NONE OR OTHER ABNORMAL CONDITIONS/PROCEDURES NOT LISTED

Code 00 – None

Code 75 – Other Conditions/Procedures not Listed

1/07 APPENDIX D


APPENDIX E

MATERNITY HOSPITAL CODES (BY COUNTY) (Item 5A and Box A)

(See following pages)

NOTE: If the place of birth is not found in this Appendix, code as follows: 0000 = Non-Hospital births, either in-state or reallocates from out-of-state. 0998 = Births in transit. For example, births occurring in taxis. 0999 = Unknown or new hospital births in-state. This includes some birthing centers. 9999 = Unknown hospital births, out-of-state only (reallocates).

Continued on next page 1/07 APPENDIX E


APPENDIX E (continued)


COUNTY HOSPITAL CODE

HOSPITAL NAME

ALAMEDA 013 ALAMEDA MED CTR – HIGHLAND CAMPUS 003 ALTA BATES MEDICAL CENTER 008 EDEN MEDICAL CENTER 014 KAISER HOSPITAL: HAYWARD 015 KAISER HOSPITAL: OAKLAND 022 ST. ROSE HOSPITAL 024 VALLEYCARE MEDICAL CENTER 026 WASHINGTON TOWNSHIP HOSPITAL ALPINE None -------------------- AMADOR 028 SUTTER AMADOR HOSPITAL BUTTE 033 ENLOE MEDICAL CENTER 031 FEATHER RIVER HOSPITAL 032 OROVILLE HOSPITAL CALAVERAS 037 MARK TWAIN ST. JOSEPH’S HOSPITAL COLUSA 038 COLUSA REGIONAL MEDICAL CENTER CONTRA COSTA 041 CONTRA COSTA REGIONAL MEDICAL CENTER 040 DOCTORS MEDICAL CENTER – SAN PABLO

CAMPUS 043 JOHN MUIR MEDICAL CENTER 045 KAISER HOSPITAL – WALNUT CREEK 749 SAN RAMON REGIONAL MEDICAL CENTER 042 SUTTER DELTA MEDICAL CENTER DEL NORTE 050 SUTTER COAST HOSPITAL EL DORADO 051 BARTON MEMORIAL HOSPITAL 054 MARSHALL HOSPITAL FRESNO 055 CLOVIS COMMUNITY HOSPITAL 058 COMMUNITY MEDICAL CENTER FRESNO 772 KAISER PERMANENTE MEDICAL CENTER 063 SELMA COMMUNITY HOSPITAL 065 SIERRA-KINGS DISTRICT HOSPITAL






HOSPITAL NAME

FRESNO (Continued) 066 ST. AGNES HOSPITAL GLENN None -------------------- HUMBOLDT 072 MAD RIVER COMMUNITY HOSPITAL 073 REDWOOD MEMORIAL HOSPITAL 075 ST. JOSEPH HOSPITAL IMPERIAL 078 EL CENTRO REGIONAL MEDICAL CENTER 081 PIONEERS MEMORIAL HOSPITAL INYO 083 NORTHERN INYO HOSPITAL KERN 091 BAKERSFIELD MEMORIAL HOSPITAL 088 DELANO REGIONAL MEDICAL CENTER 092 KERN MEDICAL CENTER 760 MERCY SOUTHWEST BIRTH CENTER 100 RIDGECREST REGIONAL HOSPITAL 730 SAN JOAQUIN COMMUNITY HOSPITAL – FBC KINGS 111 CENTRAL VALLEY GENERAL HOSPITAL 112 NAVAL HOSPITAL – LEMORE LAKE 115 REDBUD COMMUNITY HOSPITAL 114 SUTTER LAKESIDE HOSPITAL LASSEN 119 BANNER LASSEN MEDICAL CENTER LOS ANGELES 128 ANTELOPE VALLLEY HOSPITAL 288 BELLFLOWER MEDICAL CENTER 140 BEVERLY HOSPITAL 146 CALIFORNIA HOSPITAL MEDICAL CENTER 150 CEDARS SINAI MEDICAL CENTER 151 CENTINELA HOSPITAL MEDICAL CENTER 265 CITRUS VALLEY MEDICAL CENTER – QV CAMPUS 162 DANIEL FREEMAN MEMORIAL HOSPITAL 168 DOWNEY REGIONAL MEDICAL CENTER






HOSPITAL NAME

LOS ANGELES 169 EAST LOS ANGELES DOCTORS HOSPITAL (CONTINUED) 180 EAST VALLEY HOSPITAL MEDICAL CENTER 226 ENCINO/TARZANA REGIONAL MEDICAL CENTER 702 FOOTHILL PRESBYTERIAN HOSPITAL 177 GARFIELD MEDICAL CENTER 178 GLENDALE ADVENTIST MEDICAL CENTER 229 GLENDALE MEMORIAL HOSPITAL 195 GOOD SAMARITAN HOSPITAL – LOS ANGELES 183 GREATER EL MONTE COMMUNITY HOSPITAL 187 HENRY MAYO NEWHALL MEMORIAL HOSPITAL 196 HUNTINGTON MEMORIAL HOSPITAL 779 KAISER HOSPITAL: BALDWIN PARK 203 KAISER HOSPITAL: BELLFLOWER 671 KAISER HOSPITAL: LOS ANGELES, CADILLAC 205 KAISER HOSPITAL: LOS ANGELES, SUNSET 206 KAISER HOSPITAL: PANORAMA CITY 204 KAISER HOSPITAL: SOUTH BAY 729 KAISER HOSPITAL: WOODLAND HILLS 217 LA COUNTY HARBOR – UCLA MEDICAL CENTER 223 LA COUNTY KING/DREW MEDICAL CENTER 219 LA COUNTY U.S.C. MEDICAL CENTER 275 LITTLE COMPANY OF MARY – SAN PEDRO HOSP 213 LITTLE COMPANY OF MARY HOSPITAL 227 LONG BEACH MEMORIAL MEDICAL CENTER 158 LOS ANGELES COMMUNITY HOSPITAL 308 LOS ANGELES METROPOLITAN HOSPITAL 228 MEMORIAL HOSPITAL OF GARDENA 233 METHODIST HOSPITAL OF SOUTHERN CALIF 237 MISSION HOSPITAL






HOSPITAL NAME

LOS ANGELES 240 MONTEREY PARK HOSPITAL (CONTINUED) 247 NORTHRIDGE HOSPITAL MEDICAL CENTER 704 OLIVE VIEW MEDICAL CENTER 174 PACIFIC ALLIANCE MEDICAL CENTER 251 PACIFIC HOSPITAL OF LONG BEACH 280 PACIFICA HOSPITAL OF THE VALLEY 262 POMONA VALLEY HOSPITAL MEDICAL CENTER 263 PRESBYTERIAN INTERCOMMUNITY HOSPITAL 194 PROVIDENCE HOLY CROSS MEDICAL CENTER 290 PROVIDENCE ST. JOSEPH MEDICAL CENTER 191 QUEEN OF ANGELS-HOLLYWOOD – PRESBYTERIAN 272 SAN DIMAS COMMUNITY HOSPITAL 159 SAN GABRIEL VALLEY MEDICAL CENTER 278 SANTA MONICA UCLA MEDICAL CENTER 287 ST. FRANCIS MEDICAL CENTER 289 ST. JOHN’S HEALTH CENTER 133 ST. MARY’S MEDICAL CENTER 297 TORRANCE MEMORIAL MEDICAL CENTER 299 UCLA MEDICAL CENTER 303 VALLEY PRESBYTERIAN HOSPITAL 305 VERDUGO HILLS HOSPITAL 310 WEST HILLS HOSPITAL AND MEDICAL CENTER 315 WHITE MEMORIAL MEDICAL CENTER 316 WHITTIER HOSPITAL MADERA 321 MADERA COMMUNITY HOSPITAL MARIN 326 MARIN GENERAL HOSPITAL MARIPOSA None -------------------- MENDOCINO 338 MENDOCINO COAST DISTRICT HOSPITAL 342 UKIAH VALLEY MEDICAL CENTER






HOSPITAL NAME

MERCED 346 MEMORIAL HOSPITAL LOS BANOS 348 MERCY MEDICAL CENTER – COMMUNITY MODOC 352 MERCY MODOC MEDICAL CENTER, ALTURAS MONO 674 MAMMOTH HOSPITAL MONTEREY 356 COMMUNITY HOSPITAL 358 GEORGE L MEE MEMORIAL HOSPTAL 360 NATIVIDAD MEDICAL CENTER 362 SALINAS VALLEY MEMORIAL HOSPITAL NAPA 366 QUEEN OF THE VALLEY HOSPITAL 367 ST. HELENA HOSPITAL NEVADA 370 SIERRA NEVADA MEMORIAL HOSPITAL 371 TAHOE FOREST HOSPITAL ORANGE 373 ANAHEIM GENERAL HOSPITAL 374 ANAHEIM MEMORIAL MEDICAL CENTER 393 COASTAL COMMUNITIES HOSPITAL 382 FOUNTAIN VALLEY REG HOSP & MED CTR 395 GARDEN GROVE HOSPITAL & MED CNTR 387 HOAG MEMORIAL HOSPITAL 748 IRVINE REGIONAL HOSPITAL & MEDICAL CENTER 683 KAISER FOUNDATION HOSPITAL 722 LA PALMA INTERCOMMUNITY HOSPITAL 391 LOS ALAMITOS MEDICAL CENTER 394 MISSION HOSP REGIONAL MEDICAL CENTER 724 ORANGE COAST MEMORIAL MEDICAL CENTER 784 PAULARINO BIRTHING CENTER 716 PLACENTIA LINDA HOSPITAL 736 SADDLEBACK MEMORIAL MEDICAL CENTER 399 SOUTH COAST MEDICAL CENTER 400 ST. JOSEPH HOSPITAL






HOSPITAL NAME

ORANGE 401 ST. JUDE MEDICAL CENTER (CONTINUED) 403 UCI MEDICAL CENTER 761 WESTERN MEDICAL CENTER – ANAHEIM 398 WESTERN MEDICAL CENTER – SANTA ANA PLACER 406 SUTTER AUBURN FAITH HOSPITAL 410 SUTTER ROSEVILLE MEDICAL CENTER PLUMAS 414 PLUMAS DISTRICT HOSPITAL RIVERSIDE 417 CORONA REGIONAL MEDICAL CENTER 418 DESERT REGIONAL MEDICAL CENTER 420 HEMET VALLEY MEDICAL CENTER 744 INLAND VALLEY REGIONAL MEDICAL CENTER 421 JOHN F. KENNEDY MEMORIAL HOSPITAL 743 KAISER FOUNDATION HOSPITAL – RIVERSIDE 756 MORENO VALLEY COMMUNITY HOSPITAL 424 PALO VERDE HOSPITAL 425 PARKVIEW COMMUNITY HOSPITAL MED. CENTER 759 RANCHO SPRINGS MEDICAL CENTER 427 RIVERSIDE COMMUNITY HOSPITAL 428 RIVERSIDE COUNTY REGIONAL MEDICAL CNETER 430 SAN GORGONIO MEMORIAL HOSPITAL SACRAMENTO 437 KAISER HOSPITAL: SACRAMENTO 763 KAISER HOSPITAL: SOUTH SACRAMENTO 438 MERCY GENERAL HOSPITAL 442 MERCY HOSPITAL OF FOLSOM 439 MERCY SAN JUAN HOSPITAL 440 METHODIST HOSPITAL OF SACRAMENTO 441 SUTTER MEMORIAL HOSPITAL 782 THE BIRTH CENTER 443 UC DAVIS MEDICAL CENTER






HOSPITAL NAME

SAN BENITO 447 HAZEL HAWKINS MEMORIAL HOSPITAL SAN BERNARDINO 468 ARROWHEAD REGIONAL MEDICAL CENTER 449 BARSTOW COMMUNITY HOSPITAL 450 BEAR VALLEY COMMUNITY HOSPITAL 453 CHINO VALLEY MEDICAL CENTER 467 COMMUNITY HOSPITAL OF SAN BERNARDINO 771 DESERT VALLEY MEDICAL CENTER 455 DOCTORS HOSPITAL MEDICAL CENTER 732 HI DESERT MEDICAL CENTER 740 INLAND MIDWIFE SERVICES 457 KAISER FOUNDATION HOSPITAL – FONTANA 458 LOMA LINDA UNIVERSITY MEDICAL CENTER 460 MOUNTAINS COMMUNITY HOSPITAL 461 NAVAL HOSPITAL: TWENTYNINE PALMS MCAGCC 465 REDLANDS COMMUNITY HOSPITAL 466 SAN ANTONIO COMMUNITY HOSPITAL 469 ST. BERNARDINE MEDICAL CENTER 470 ST. MARY REGIONAL MEDICAL CENTER 477 VICTOR VALLEY COMMUNITY HOSPITAL 693 WEED ARMY COMMUNITY HOSPITAL SAN DIEGO 479 ALVARADO HOSPITAL MEDICAL CENTER 711 BEST START BIRTH CENTER 491 FALLBROOK HOSPITAL DISTRICT 492 GROSSMONT HOSPITAL 497 KAISER HOSPITAL: SAN DIEGO 501 NAVAL HOSPITAL: CAMP PENDLETON 502 NAVAL MEDICAL CENTER (BALBOA) 504 PALOMAR MEDICAL CENTER






HOSPITAL NAME

SAN DIEGO 505 PARADISE VALLEY HOSPITAL (CONTINUED) 666 POMERADO HOSPITAL 480 SCRIPPS MEMORIAL HOSPITAL – CHULA VISTA 506 SCRIPPS MEMORIAL HOSPITAL – LA JOLLA 765 SCRIPPS MEMORIAL HOSPITAL: ENCINITAS 498 SCRIPPS MERCY HOSPITAL 486 SHARP CHULA VISTA MEDICAL CENTER 778 SHARP MARY BIRCH HOSPITAL FOR WOMEN 507 TRI-CITY MEDICAL CENTER

508 UCSD MEDICAL CENTER SAN FRANCISCO 510 CALIFORNIA PACIFIC MEDICAL CENTER 515 KAISER FOUNDATION HOSPITAL – SAN FRANCISCO 521 SAN FRANCISCO GENERAL HOSPITAL 525 ST. LUKE’S HOSPITAL 527 UNIV. OF CALIFORNIA MEDICAL CENTER SAN JOAQUIN 529 DAMERON HOSPITAL 532 DOCTORS HOSPITAL OF MANTECA 531 LODI MEMORIAL HOSPITAL 536 SAN JOAQUIN GENERAL HOSPITAL 537 ST. JOSEPH’S MEDICAL CENTER 538 SUTTER TRACY COMMUNITY HOSPITAL SAN LUIS OBISPO 541 FRENCH HOSPITAL 545 SIERRA VISTA REGIONAL MEDICAL CENTER 546 TWIN CITIES COMMUNITY HOSPITAL SAN MATEO 549 KAISER FOUNDATION HOSPITAL – REDWOOD CITY 553 MILLS PENINSULA HEALTH SERVICES 554 SEQUOIA HOSPITAL 550 SETON MEDICAL CENTER






HOSPITAL NAME

SANTA BARBARA 556 COTTAGE HOSPITAL 557 GOLETA VALLEY COTTAGE HOSPITAL 559 LOMPOC HEALTH CARE DISTRICT 560 MARIAN MEDICAL CENTER SANTA CLARA 568 COMMUNITY HOSPITAL LOS GATOS – SARATOGA 569 EL CAMINO HOSPITAL 570 GOOD SAMARITAN HOSPITAL 571 KAISER PERMANENTE MED CNTR: SANTA CLARA 777 LUCILE PACKARD CHILDREN’S HOSPITAL 573 O’CONNOR HOSPITAL 566 REGIONAL MEDICAL CENTER OF SAN JOSE 577 SANTA CLARA VALLEY MEDICAL CENTER 578 SANTA TERESA COMMUNITY HOSPITAL 746 ST. LOUISE REGIONAL HOSPITAL SANTA CRUZ 583 DOMINICAN SANTA CRUZ HOSPITAL 775 SUTTER MATERNITY & SURGERY CENTER 586 WATSONVILLE COMMUNITY HOSPITAL SHASTA 587 MAYERS MEMORIAL HOSPITAL 589 MERCY MEDICAL CENTER SIERRA None -------------------- SISKIYOU 595 FAIRCHILD MEDICAL CENTER 592 MERCY MEDICAL CENTER MT. SHASTA SOLANO 597 60TH MEDICAL GROUP 600 KAISER HOSPITAL: VALLEJO 599 NORTHBAY MEDICAL CENTER 603 SUTTER SOLANO MEDICAL CENTER SONOMA 751 KAISER HOSPITAL: SANTA ROSA 607 PETALUMA VALLEY HOSPITAL 611 SANTA ROSA MEMORIAL HOSPITAL






HOSPITAL NAME

SONOMA 612 SONOMA VALLEY HOSPITAL (CONTINUED) 605 SUTTER MEDICAL CENTER 770 WOMEN’S HEALTH AND BIRTH CENTER STANISLAUS 615 DOCTORS MEDICAL CENTER 616 EMANUEL HOSPITAL 617 MEMORIAL MEDICAL CENTER 620 OAK VALLEY DISTRICT HOSPITAL SUTTER 623 FREMONT MEDICAL CENTER TEHAMA 626 ST. ELIZABETH HOSPITAL TRINITY None -------------------- TULARE 631 KAWEAH DELTA DISTRICT HOSPITAL 634 SIERRA VIEW DISTRICT HOSPITAL 636 TULARE DISTRICT HOSPITAL TUOLUMNE 639 SONORA COMMUNITY HOSPITAL VENTURA 642 COMMUNITY MEMORIAL HOSPITAL – SAN

BUENAVENTURA 646 LOS ROBLES REGIONAL MEDICAL CENTER 656 SIMI VALLEY HOSPITAL & HEALTH CARE SERVICES 651 ST. JOHN’S PLEASANT VALLEY HOSPITAL 658 ST. JOHN’S REGIONAL MEDICAL CENTER 645 VENTURA COUNTY MEDICAL CENTER YOLO 660 SUTTER DAVIS HOSPITAL 661 WOODLAND HEALTH CARE YUBA NONE --------------------

1/07 APPENDIX E


APPENDIX F

COUNTY CODES AND LOCAL REGISTRTON DISTRICT CODES ** Items 5D, 24B and Box B)

The Following Codes are Used for California Counties: 001 Alameda 021 Marin 041 San Mateo 002 Alpine 022 Mariposa 042 Santa Barbara 003 Amador 023 Mendocino 043 Santa Clara 004 Butte 024 Merced 044 Santa Cruz 005 Calaveras 025 Modoc 045 Shasta 006 Colusa 026 Mono 046 Sierra 007 Contra Costa 027 Monterey 047 Siskiyou 008 Del Norte 028 Napa 048 Solano 009 El Dorado 029 Nevada 049 Sonoma 010 Fresno 030 Orange 050 Stanislaus 011 Glenn 031 Placer 051 Sutter 012 Humboldt 032 Plumas 052 Tehama 013 Imperial 033 Riverside 053 Trinity 014 Inyo 034 Sacramento 054 Tulare 015 Kern 035 San Benito 055 Tuolumne 016 Kings 036 San Bernardino 056 Ventura 017 Lake 037 San Diego 057 Yolo 018 Lassen 038 San Francisco 058 Yuba 019 Los Angeles 039 San Joaquin

Madera 040 San Luis Obispo

020 ** For purpose of assigning LRD codes (electronic record positions 19-20) only, the following independent health jurisdictions are coded as indicated: 061 City of Berkeley 062 City of Long Beach 063 City of Pasadena

1/07 APPENDIX F


APPENDIX G

ATTENDANT CODES (Box D)

CODE TITLE DEFINITION

1 Medical Doctor FACOG Intern M.D. Resident

Physician Medical Doctor

2 Doctor of Osteopathy D.O.

Doctor of Osteopathy

3 Certified Nurse Midwife C.N.M.

Certified Nurse Midwife

4 Registered Nurse/ Licensed Midwife/ Physician’s AssistantF.N.P. L.M. M.A. N.P. P.A. P.A.C. R.N. R.N.C. R.N.P.

Family Nurse Practitioner Licensed Midwife Medical Assistant Nurse Practitioner Physician’s Assistant Physician’s Assistant Certified Registered Nurse Registered Nurse Consultant Registered Nurse Practitioner

5 Other Midwife I.N.M. Midwife R.N.M. S.N.M.

Interim Nurse Midwife (license pending) Without License Registered Nurse Midwife (license pending) Student Nurse Midwife (license pending)

Continued on next page 1/07 APPENDIX G


APPENDIX G (continued)

ATTENDANT CODES (Box D)

CODE TITLE DEFINITION Other C.N. Clinical Trainee

6

Clinical Nurse

Coroner D.C. Chiropractor E.M.T. Emergency Medical Technician Father Fireman C.P.T. Certified Friend L.V.N. Licensed Vocational Nurse M.R.C. Medical Records Clerk M.S. Medical Student Paramedic MCIP Parents Relative Other

9 Unknown or Unattended

1/07 APPENDIX G


APPENDIX H SEALING ELECTRONIC RECORDS There are two types of sealed birth records that require different sealing processes: Type 1 Sealings: Adoptions, Adjudications, and Acknowledgements; Type 2 Sealings: Fraudulent Records, Duplicates and Cancellations. Type 1 Sealings:

Computer entries must be altered to the point that the identity of the individual named on the certificate is not detectable. Index entries (whether on paper, film, microfiche or computer) are to be deleted for all

sealed records. Therefore, when a sealing notice is received the following entries, (listed by Certificate Item Number and Name) must be deleted from each record contained in the electronic file:

Certificate Item Number Name Vital Record Identification Number; State File Number; 1A Child’s First Name; 1B Child’s Middle Name; 1C Child’s Last Name 5A Child’s Place of Birth; 5B Child’s Birth Address; 5C Child’s City of Birth; 6A Father’s First Name; 6B Father’s Middle Name; 6C Father’s Last Name; 9A Mother’s First Name; 9B Mother’s Middle Name; 9C Mother’s Maiden Name; 12A Parent’s or Other Informant’s Signature; 13A Attendant’s or Certifier’s Signature – Degree or Title; 13B Attendant’s or Certifier’s License Number; 13D Typed Name, Title, and Mailing Address of Attendant; 14 Typed Name and Title of Certifier Other Than Attendant; 15B Child’s Death State File Number; 24A Mother’s Street Address; 24C Mother’s City of Residence; 24E Mother’s Zip Code of Residence; Box A Maternity Hospital Code; Hospital Ownership;

Continued on next page 1/07 APPENDIX H


APPENDIX H (continued) SEALING ELECTRONIC RECORDS

Certificate Item Number NameBox D Type of Attendant/Certifier (Box D); Census Tract; Child’s Social Security Number; Census Place Code (NCHS 3-digit code); 32 Father’s Social Security Number; 33 Mother’s Social Security Number;

Type 2 Sealings: The cancelled, duplicates and fraudulently filed records should be entirely removed. This document applies to the electronic record only. Please refer to the “Handbook for Birth and Death Registration” for instructions on sealing the paper certificates.

1/07 APPENDIX H

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