Fetal Death Certificates

For any questions regarding fetal death certification, please contact your Galveston County Health District Vital Statistics 409.765.2595.

Fetal death certification uses the original pink Death Certification paper forms, which are found on the appropriate hospital Units (Newborn Nursery, Labor and Delivery, Postpartum Unit). Death Certificates MUST be completed and mailed to the Galveston County Health District within 5 days of the date of death.

Instructions for completing the Fetal Death Certificate

  1. Complete the entire original pink fetal death certificate. Typed certificates are preferred, but clear legible handwritten certificates are acceptable (use black or blue ink).
  2. Complete lines 1 thru 18B. If the mother's name prior to first marriage is the same as written on item 9, then write 'same' on item 11. If the information about the father is not provided, items 14, 15, and 16 enter unknown..
  3. Important: On items 17b, 18a, 18b the certifying physician will sign, date, and indicate their credentials.
  4. Complete lines 26A thru 32.
  5. Complete remaining lines 34 thru 53. If WIC information is not provided, write 'unknown' on item 45.
  6. Send the completed Fetal Death Certificate along with the Decedent Affairs paperwork to Autopsy Service. All items outlined above MUST BE COMPLETED, otherwise the Death Certificate will be sent back to the certifying physician to be properly completed. If there are no conditions contributing to fetal death or risk factors in the pregancy check unknown or none of the above.

    Please do not:
    1. Use whiteout or erasers or correction fluid or cross out mistakes on the original pink death certificate
    2. Do not punch holes on the original pink death certificate

    Step-by-step instructions on how to complete the Fetal Death Certificate are available here.

If you have any questions or concerns regarding the fetal death certificate, please call Autopsy Service at 772.2859.