PACKET B
(SAMPLE: COVER LETTER)
Dear (Parent):
We want to help you register your child’s birth and get a birth certificate. This is especially important because you did not give birth in a licensed hopspital.
The attached out-of-hospital birth registration packet wil tell you exactly what you need to do to register your child’s birth. H&SC Section 102400 states: "Each live birth shall be registered with the local registrar of births and deaths for the district in which the birth occurred within 10 days following the date of event." California law requires birth registration at the local health department to be completed within 10 days of the birth. Any birth registered on or after the child' first birthday must be processed by the Office of Vital Records (OVR) as a Delayed Registmtion of Birth (VS 85). This requires a statutory fee of $19 (subject to change). If the requirement for a VS 85 cannot be met then it will be necessary to apply for a Court Order Delayed Registration of Birth (VS 108). This form must be processed by OVR. Out of Hospital are increaseingly more difficult to register the further from the date of the birth that the registration is attempted.
You can assit our office to make the birth registration process as smooth as possible by CAREFULLY READING THE OUT-OF-HOSPITAL BIRTH REGISTRATION PACKET. Then make sure you have all your required documentation before coming in for an appointment.
You will need to set up an appointment to register the birth. It may take up to _________________ from the day you call for an appointment until your scheduled appointment. Please call
( ) ___________________ to schedule your appointment. You may use this telephone number if you have questions regarding the contents of the packet.
Sincerely,
Chief Deputy Registrar, Vital Records
County of _____________________
LIST B
For Planned Births Out of Hospital With a Certified Nurse Midwives/Licensed Midwife
Here's what needs to be brought to the birth registration appointment.
1. The Certified Nurse Midwives/Licensed Midwife and parent(s) must have one valid picture I.D. issued to them by the government, such as:
Driver's license or California I.D. from the DMV (Department of Motor Vehicles)
Passport
Military I.D.
Green Card
2. Affidavit of child’s birth information - CERTFEED NURSE MIDWIFE/LICENSED MIDWIFE VERSION
This form must be completed prior to the appointment. There is no time to do it during the appointment.
Answer every question on the form.
Obtain all necessary signatures.
Call the LRD if you have any questions.
3. Medical verification of mother's pregnancy (letter or pregnancy test verification form).
Verification must be:
From a licensed doctor or clinic in California.
On the doctor or clinic's official stationary (not a prescription pad).
Signed by the California doctor or clinic representative/nurse - not stamped.
The doctor or certified nurse midwife/licensed midwife who writes the letter must include a copy of his or her current California issued professional license.
The letter must have the following infomiation:
The mother's name.
The date she was first seen by the doctor.
The results of pregnancy tests or exams.
The date of her last menstrual period.
The date the baby was expected to be bom (due date).
If you do not have any of the above information, you can use a signed copy of the certified nurse midwife's/licensed midwife/s prenatal care chart
4. The child.
The appointment shall not conducted if the child is not present.
5. A certified nurse midwife/licensed midwife who was present at the birth, and who is willing to serve as a witness. If the certified nurse midwife/licensed midwife is not signing the birth certificate - one witness who was at the birth must sign the birth certificate. The witness must have a valid picture I.D. issued by the government.
That person can be:
Husband or other family member
Friend.
Child old enough towrite his or her name. If the witness is a child without a valid picture I.D., you can use a picture of the child, plus the child's social security card and birth certificate (this applies ONLY to children).
6. Two (2) documents that prove where the mother lives.
One (1) document dated BEFORE the child was born.
One (1) document dated AFTER the child was born.
Here are some examples of documents that can be used. Originals are preferred but copies areacceptable. If you don't have enough documents in your name, you can bring documents in the child's father's name if you also bring a certified copy of your marriage license:
Utility bills (gas, electric, telephone, etc.) with the mother's name, date, and mailing address.
A letter sent to the mother with her name, address, and postmark. The mother's name must be written as first and last name, not as Mrs. or Ms.
A rent receipt with the mother's name and address, and the date (month, day, and year), plus the rental agreement with the manager's or landlord's name and phone number.
A mortgage payment which shows the name of the mother and father, along with a copy of the deed.
A Medi-Cal notice of action addressed to the mother.
If the mother has moved since the child was born she must bring in one of the following documents, in addition to the verification for the month before the child's birth:
A rent receipt showing the deposit and rent or lease of the new residence.
Escrow papers and a copy of the deed.
A piece of mail showing the old address with the forwarding label attached.
7. One (1) letter from a person not related to the mother nor living with her:
The letter must be handwritten (no form letters).
The letter must state that the person writing the letter knows:
1) that the mother was pregnant:
2) that the child was born:
3) the date the child was born: and
4) the address where the child was born.
The letter must contain the full name, address , and phone numbers (both home and work) of the person writing the letter.
The letter must be notarized and have a notary's stamp or seal.
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