Certificate of Birth Resulting in Stillbirth - Arizona Department of ... - azdhs Preview on Page 1

Certificate of Birth Resulting in Stillbirth - Arizona Department of ... - azdhs 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the child's name in all capital letters as listed on the Fetal Death Certificate. Ensure accuracy and avoid abbreviations.
  3. Select the sex of the child by checking the appropriate box for male or female.
  4. Indicate the type of delivery (single, twin, etc.) and specify if it was a multiple birth, ensuring to list them in order based on their birth time.
  5. Fill in the date and time of delivery using numeric figures only, including A.M. or P.M. for clarity.
  6. Provide details about the location of delivery, including the name of the hospital or clinic, or street address for home deliveries.
  7. Complete parental information by entering names and dates of birth for both parents in all capital letters, ensuring correct spelling throughout.
  8. Sign and date where indicated to verify that all information is accurate before submission.

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