Fetal Death Certificates
Fetal death certification makes use of original pink Death Certification paper forms, which are found on the appropriate hospital Units (Newborn Nursery, Labor and Delivery, Postpartum Unit).
Instructions for completing the Fetal Death Certificate1. Make a copy of the original pink fetal death certificate
2. On the copied death certificate complete lines 1 thru 17A
3. Complete lines 17B thru 18B
4. Complete lines 26A thru 29
5. Complete remaining lines 34 thru 53
On the original pink fetal death certificate, the cetifying physician will sign, print medical license number and print the date on line 18A.Send the completed copy and the original pink fetal death certificate along with the Decedent Affairs paperwork to Autopsy Service.
Please do not:
1. Write on the original pink death certificate
2. Do not punch holes on the original pink death certificate
If you have any questions or concerns regarding the fetal death certificate, please call Autopsy Service at 22859.
509 Clinical Sciences Building
Phone: x22859 - Fax: x29045
Hours of Operation
Monday thru Friday
8:00am to 4:30pm
Closed on weekends and holidays
For any questions regarding fetal death certification, please contact:
Shara Nychole Upton