Missouri Code of State Regulations
Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES
Division 10 - Office of the Director
Chapter 10 - Vital Records
Section 19 CSR 10-10.060 - Report of Fetal Death

(1) The report of fetal death shall include the following items: registration district number; registrar's number; fetus name; city, town or location of delivery; county of delivery; date of delivery; sex of fetus; place of delivery; if residence (home) delivery, was it planned that way-yes or no; facility name; mother's name, maiden surname, date of birth, residence (state, county, city, town or location), zip code, street and number, inside city limits-yes or no, years living at present address; father's name, date of birth; immediate and underlying cause of death and specify if cause is fetal or maternal; other significant conditions; fetus died before labor, during labor or delivery or unknown (specify); attendant's name and title, Missouri license number; name and title of person completing report; burial, cremation, other (specify); cemetery or crematory, location (city or town, state); date; name and address of facility; informant; registrar's signature; date received by local registrar; mother of Hispanic origin-no or yes; father of Hispanic origin-no or yes; mother's race; father's race; mother's education; father's education; mother participated during pregnancy (check all that apply); live births-now living; live births-now dead; date of last live birth; other terminations, date of last other termination; was mother married to father-yes or no; date last normal menses began (month, day, year); month pregnancy prenatal care began (specify); prenatal visits (total number); birth weight; crown heel length; clinical estimate of gestation (weeks); plurality (specify); if not single birth-born first, second, third, etc. (specify); mother transferred from another facility or physician's office prior to delivery-yes or no and if yes enter name of facility; medical risk factors for this pregnancy (check all that apply); other risk factors for this pregnancy (complete all items); obstetric procedures (check all that apply); complications of labor or delivery or both (check all that apply); method of delivery (check all that apply); congenital anomalies of child (check all that apply).