Fetal Death Certificates



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

Complete the original pink fetal death certificate. Typed certificates are preferred, but clear legible handwritten certificates are acceptable (use black or blue ink).

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 can be left blank.

Important: On items 17b, 18a, 18b the certifying physician will sign, date, and indicate their credentials.

Complete lines 26A thru 29.

Complete remaining lines 34 thru 53. If WIC information is not provided, write 'unknown' on item 45.

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.

Please do not:
1. Use whiteout or erasers or correction fluid 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 22859.

 




Autopsy Service
Administrative Office


509 Clinical Sciences Building
Phone: x22859 - Fax: x29045

Hours of Operation
Monday thru Friday
8:30am to 5:00pm
Closed on weekends and holidays

For any questions regarding fetal death certification, please contact your Departmental TER Administrator