Washington Administrative Code
Title 246 - Health, Department of
HEALTH INFORMATION
Chapter 246-491 - Vital statistics - Certificates
Section 246-491-159 - Items on birth and death certifications and informational copies

Vital Record Item

Long Form Certification of Death

Short Form Certification of Death

Informational Copy of Death

State file number

Yes

Yes

Yes

Date certificate issued

Yes

Yes

Yes

Fee number

Yes

Yes

Yes

Decedent's legal first and middle name(s)

Yes

Yes

Yes

Decedent's last name(s)

Yes

Yes

Yes

County of death

Yes

Yes

Yes

Date of death

Yes

Yes

Yes

Hour of death

Yes

Yes

Yes

Sex

Yes

Yes

Yes

Age

Yes

Yes

Yes

Social Security number

Yes

No

No

Place of death

Yes

Yes

Yes

Facility or address of death

Yes

Yes

Yes

City, state, zip

Yes

Yes

Yes

Hispanic origin

Yes

Yes

Yes

Race

Yes

Yes

Yes

Residence street

Yes

Yes

Yes

Residence city, state, zip

Yes

Yes

Yes

Residence county

Yes

Yes

Yes

Is residence inside city limits?

Yes

Yes

Yes

Tribal reservation

Yes

Yes

Yes

Length of time at residence

Yes

Yes

Yes

Birth date

Yes

Yes

Yes

Birthplace

Yes

Yes

Yes

Father/parent name

Yes

Yes

Yes

Mother/parent name

Yes

Yes

Yes

Marital status

Yes

Yes

Yes

Spouse

Yes

Yes

Yes

Method of disposition of remains

Yes

Yes

Yes

Place of disposition of remains

Yes

Yes

Yes

City, state of disposition of remains

Yes

Yes

Yes

Disposition date of remains

Yes

Yes

Yes

Occupation

Yes

Yes

Yes

Industry

Yes

Yes

Yes

Education

Yes

Yes

Yes

U.S. Armed Forces

Yes

Yes

Yes

Informant name

Yes

Yes

Yes

Informant's relationship to decedent

Yes

Yes

Yes

Informant's address

Yes

Yes

Yes

Funeral facility

Yes

Yes

Yes

Funeral facility address

Yes

Yes

Yes

Funeral facility city, state, zip

Yes

Yes

Yes

Funeral director name

Yes

Yes

Yes

Cause of death (A, B, C, and D)

Yes

No

No

Other conditions contributing to death

Yes

No

No

Date of injury

Yes

No

No

Hour of injury

Yes

No

No

Injury at work

Yes

No

No

Place of injury

Yes

No

No

Location of injury

Yes

No

No

City, state, zip of injury

Yes

No

No

County of injury

Yes

No

No

Describe how the injury occurred

Yes

No

No

If transportation injury, specify

Yes

No

No

Manner of death

Yes

No

No

Autopsy

Yes

No

No

Were autopsy findings available to complete cause of death?

Yes

No

No

Did tobacco use contribute to death?

Yes

No

No

Pregnancy status if female

Yes

No

No

Certifier name

Yes

No

No

Certifier title

Yes

No

No

Certifier address

Yes

No

No

Certifier city, state, zip

Yes

No

No

Date signed by certifier

Yes

No

No

Case referred to ME/coroner?

Yes

No

No

File number

Yes

No

No

Attending physician

Yes

No

No

Local deputy registrar

Yes

Yes

Yes

Date received by local deputy registrar

Yes

Yes

Yes

Vital Record Item

Certification of Fetal Death

Certification of Birth

State file number

Yes

Yes

Date certificate issued

Yes

Yes

First and middle name(s) of fetus

Yes

Yes

Last name(s) of fetus

Yes

Yes

Sex

Yes

Yes

Date and time of delivery

Yes

Yes

Place of delivery (city, county, state)

Yes

Yes

Name of facility

Yes

Yes

Mother/parent's name prior to first marriage

Yes

Yes

Mother/parent's place of birth

Yes

Yes

Mother/parent's date of birth or age at the time

Yes

Yes

Father/parent's current legal name

Yes

Yes

Father/parent's place of birth

Yes

Yes

Father/parent's date of birth or age at the time

Yes

Yes

Name and title of person completing cause of

Yes

No

Date signed by person completing cause of

Yes

No

Name and title of person delivering the fetus

Yes

No

Method of disposition

Yes

Date of disposition

Yes

No

Place of disposition

Yes

No

Disposition location - City/town, and state

Yes

No

Funeral facility name

Yes

No

Funeral facility address

Yes

No

Funeral director name

Yes

No

Initiating cause/condition

Yes

No

Other significant causes or conditions

Yes

No

Estimated time of fetal death

Yes

No

Was an autopsy performed?

Yes

No

Was a histological placental examination

Yes

No

Local deputy registrar

Yes

No

Data record filed

Yes

Yes

Fee number

Yes

Yes