The Child Birth Certificate Texas form is an essential document designed to record all vital data concerning the birth of a child in Texas. It serves not only as a legal testament to a child's birth but also establishes important details like age, citizenship, and parentage, which are necessary throughout the individual's life. The form requires careful and precise input from parents, as it lays the foundation for many future processes and rights. Click the button below to ensure this crucial document is accurately completed for your child’s secure future.
The Child Birth Certificate Texas form is a comprehensive document designed to collect all necessary information to legally register a child's birth within the state. Used primarily by hospitals and birthing centers, this form gathers details ranging from the newborn's and mother's identifying information, including names, addresses, and social security numbers, to specific medical and demographic data related to both the childbirth and parents' backgrounds. It prompts for details on the childbirth, like time, date, location, and the newborn's health at birth, and extends to include parental data such as education, race, and marital status. The form also inquires about parental consent for the child's inclusion in the Texas Immunization Registry. Vital for establishing the child's legal identity, citizenship, and parentage, this document serves multiple purposes throughout a person’s life, acting as a basis for obtaining medical or government services, school admissions, and more. Ensuring accuracy on this form is crucial as corrections can be difficult and costly. Furthermore, it facilitates the process for applying for the newborn's social security card and, if applicable, Medicaid, by forwarding the information to the respective agencies. It underscores the importance of meticulous completion, safeguarding against unauthorized release of information to protect family confidentiality, while providing a pivotal step in recognizing and securing a child's identity in Texas.
Mother’s Worksheet for Child’s Birth Certificate
FOR HOSPITAL USE ONLY:
MOTHER MR# _____________________________
NEWBORN MR# ________________________________
MEDICAID # _______________________________
DELIVERING DR ________________________________
RM # ____________
The information you provide on this worksheet is used to create your child’s birth certificate. The birth certificate is a legal document used to prove your child’s age, citizenship and parentage. Your child will use the birth certificate throughout his/her life. The State of Texas safeguards against the unauthorized release of identifying information from birth certificates to protect the confidentiality of parents and their child.
Please PRINT your responses carefully and accurately as errors are difficult and expensive to correct.
CHILD’S PLACE OF BIRTH
Name of Hospital or Location
Address
State
County
City
Zip Code
CHILD’S INFORMATION
Time of Birth
Date of Birth
Plurality (please circle one)
Am / Pm
Single / Twin / Triplets / Quadruplets / Quintuplets
Birth Order (please circle one)
Number of Infants Born Alive at this Birth? (please circle one)
First / Second / Third / Fourth / Fifth
One / Two / Three / Four / Five
MOTHER’S CURRENT LEGAL NAME
First Name
Middle Name
Last Name
Suffix
CHILD’S LEGAL NAME
VS-109.1 REV 2/2005
MOTHER’S RESIDENCE ADDRESS
Residence Address
Apartment Number
State/Foreign Country
City/Town/Location
Zip Code / Extension
Inside City Limits?
□ Yes
□ No
MOTHER’S MAILING ADDRESS
(If same as residence address, LEAVE THIS SECTION BLANK)
Mailing Address
MOTHER’S INFORMATION
Place of Birth (State/Foreign Country/Territory)
Social Security
Apply for Baby’s Social Security?
Did Mother Give up Rights to the Child?
Date Rights Given Up?
□ Yes □ No
Occupation
Type of Business
Mother’s Education
□8th grade or less
□9th – 12th grade, no diploma
□High School graduate or GED completed
□Some College credit, but no degree
□Associate degree (e.g., AA, AS)
□Bachelor’s degree (e.g., BA, AB, BS)
□Master’s degree (e.g., MA, MS, MEng, MEd, MSW, MBA)
□Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, LLB, JD)
Is Mother of Hispanic Origin?
□No, not Spanish / Hispanic / Latina
□Yes, Mexican, Mexican American, Chicana
□Yes, Puerto Rican
□Yes, Cuban
□Yes, other Spanish / Hispanic / Latina
Specify______________
What is Mother’s Race?
□ White
□ Vietnamese
□ Black/African American
□ Other Asian________
□ American Indian/Alaska Native
□ Native Hawaiian
(Name of the enrolled or principal tribe)
□ Guamanian or
Chamorro
□
□ Samoan
Asian Indian
□ Chinese
□ Other Pacific Islander
□ Filipino
Specify
□ Japanese
□ Other
□ Korean
□ Unknown
MOTHER’S HEALTH INFORMATION
Did you receive WIC for this Birth?
Height
Weight Before Pregnancy
Weight At Delivery
How many cigarettes did you smoke before and during pregnancy?
Three Months Before Cigs/Day: ____
Packs/Day: ___
First Three Months
Cigs/Day: ____
Second Three Months Cigs/Day: ____
Third Trimester
MOTHER’S MARITAL STATUS (Please read carefully)
If you are married, your husband may be listed as the father on the birth certificate, or the information may be left blank.
If you are not married, the father’s name may be listed on the birth certificate only if both parents complete an Acknowledgment of Paternity.
If you are or have been married to someone other than the biological father of this child, or have been married to someone other than the biological father within 300 days before this child’s birth, the Acknowledgment of Paternity must also include a Denial of Paternity from your husband or former husband to allow the biological father’s information to be listed on the birth certificate.
□ Yes, Currently Married
□ Yes, Never Married
□ Yes, Divorced
□ Yes, Widowed
□Yes, Married – (no paternity information on birth certificate)
Have you been married to someone other than the biological father in the 300 days before the child’s birth? □ Yes □ No
Do you want to complete an Acknowledgement of Paternity? □ Yes
MOTHER’S NAME PRIOR TO HER FIRST MARRIAGE
FATHER’S INFORMATION (Biological father)
Legal First Name
Father’s Education
Is Father of Hispanic Origin?
□No, not Spanish / Hispanic / Latino
□Yes, Mexican, Mexican American, Chicano
□Yes, other Spanish / Hispanic / Latino
What is Father’s Race?
□ Other Asian
□ Asian Indian
Has Paternity – Genetic Testing Been Done?
State/Foreign Country/Territory
PRESUMED FATHER’S INFORMATION (Complete ONLY if applicable)
Zip Code Extension
MOTHER’S MEDICAID INFORMATION (Complete ONLY if applicable)
Mother’s Medicaid Name
Mother’s Medicaid Number
IMMTRAC REGISTRY
Do you consent for your baby’s immunization information to be included in the statewide Immunization Registry and to share the immunization information with registered providers? □ Yes □ No
Congratulations on the birth of your new Little Texan!
Texas Vital Statistics would like to take this opportunity to answer some most commonly asked questions about birth certificates in Texas. . .
“How do I get a copy of my baby’s birth certificate?”
You can request and purchase a certified copy of your child’s birth certificate from the local registrar’s office located in the city or county where the birth occurred, or from the Texas Vital Statistic office located in Austin, Texas.
A CERTIFIED BIRTH CERTIFICATE is a permanent legal document filed in the State of Texas that establishes your child’s identity and is used to apply for medical or government services, passports, school admission, etc.
“When will I receive my baby’s social security card?”
If you answered “Yes” to the question, “Apply for baby’s social security number?”, the birth information will be forwarded to the Social Security Administration as soon as the Texas Vital Statistic office receives the data from the hospital. The Social Security Administration then requires 2-3 weeks to process the information. A social security card will be mailed to the mother’s mailing address as provided in this worksheet. The entire process usually takes 4-6 weeks to complete.
“When will I receive my baby’s Medicaid number?”
If you provided an answer for the questions “Mother’s Medicaid Name?” and “Mother’s Medicaid Number?”, the birth information will be forwarded to the Medicaid office as soon as the Texas Vital Statistic office receives the data from the hospital. Medicaid then requires 2-3 weeks to process the information. An Infant Medicaid card will be mailed to the mother’s mailing address as provided in this worksheet. The entire process usually takes 4-6 weeks to complete.
Medical Data Worksheet for Child’s Birth Certificate
This form to be completed by hospital staff. This data will be used to populate the medical data portion of the birth certificate for the newborn. The medical data is required to be reported within five days of the birth. [HSC §192.003]
PATIENT REFERRENCE:
MOTHER MR# _________________________________________
NEWBORN MR# ___________________________________________
MOTHER’S NAME ______________________________________
NEWBORN NAME _________________________________________
MEDICAID# ___________________________________________
DOB ____________________________________________________
DELIVERING DR _______________________________________
DATE AOP SENT__________________________________________
MOTHER TRANSFERRED _______________________________
SOURCE OF PAYMENT FOR DELIVERY ______________________
□ Born at Facility
□ Born En Route
□ Foundling
□ Home Birth
Prenatal Care □ Yes □ No □ Unknown
Date of First Visit ____/____/______
Date of Last Visit ____/____/______
Total Number of Prenatal Visits for this Pregnancy: ________
Date Last Normal Menses Began ___/___/_____
Pregnancy History
Live births now living (Do not include this birth. For multiple deliveries, do not include the 1st born in the set if completing this worksheet for that child. If none enter “0”.): _____
Live births now dead (Do not include this birth. For multiple deliveries, do not include the 1st born in the set if completing this worksheet for that child. If none enter “0”.): _____
Date of last live birth: ____/______
MM YYYY
Number of other pregnancy outcomes (Include fetal losses of any gestational age. If this was a multiple delivery, include all fetal losses delivered before this infant in the pregnancy.
If none enter “0”.): _____
Date of last other pregnancy outcome: ____/______
Infections Present and/or Treated During Pregnancy
□ Gonorrhea
□ Hepatitis B
□ Syphilis
□ Hepatitis C
□ Chlamydia
□ None of the above
Source of Prenatal Care
(check all that apply)
□ None
□ Midwife
□ Hospital Clinic
□Other, Specify __________________
□ Public Health Clinic
□ Private Physician
Risk Factors in this Pregnancy (check all that apply)
Diabetes
□Prepregnancy (diagnosis prior to this pregnancy)
□Gestational (diagnosis in this pregnancy)
Hypertension
□Prepregnancy (chronic)
□Gestational (PIH, preeclampsia)
□Eclampsia
□Previous preterm birth
□Other previous poor pregnancy outcome (includes perinatal death, small-for- gestational age/intrauterine growth restricted birth)
□Pregnancy resulted from infertility treatment
□Fertility-enhancing drugs, artificial insemination or intrauterine insemination
□Assisted reproductive technology
□Mother had a previous cesarean delivery
If yes, how many?_____
□Antiretrovirals administered during pregnancy or at delivery
□None of the above
HIV Test
HIV test done Prenatally
HIV test done at Delivery
Obstetric Procedures (check all that apply)
□Cervical cerclage
□Tocolysis
External cephalic version
□Successful □ Failed
Characteristics of Labor & Delivery
□Induction of labor
□Augmentation of labor
□Non-vertex presentation
□Steroids (glucocorticoids) for fetal lung maturation received by mother prior to delivery
□Antibiotics received by mother during labor
□Chorioamnionitis or maternal temperature > = 38 degrees C or
100.4degrees F
□Moderate/heavy meconium staining of the amniotic fluid
□Fetal intolerance of labor was such that one or more of the following actions was taken: in-utero resuscitative measures, further assessments, or operative delivery
□Epidural or spinal anesthesia during labor
Maternal Morbidity – Complications associated with Labor & Delivery
□Maternal transfusion
□Third or forth degree perineal laceration
□Ruptured uterus
□Unplanned hysterectomy
□Admission to intensive care unit
□Unplanned operating room procedure following delivery
Onset of Labor (check all that apply)
□Premature Rupture of the Membranes [prolonged > =12 hours]
□Precipitous Labor [< 3 hours]
□Prolonged Labor [> = 20 hours]
Method of Delivery
Was delivery with forceps attempted but unsuccessful?
Was delivery with vacuum extraction attempted but unsuccessful?
Fetal presentation at birth
□ Other, _________________________
□ Cephalic
□ Breech
Final route and method of delivery
□ Vagina/Spontaneous
□ Vagina/Forceps □ Vagina/Vacuum
If cesarean, was a trial of labor attempted?
□ Cesarean
Child’s Health Information
Birth Weight
________ Grams, or ________LB. ________OZ.
Obstetric Estimate of Gestation (completed weeks): _________
Child’s Sex: □ Male □ Female □ Not yet determined
Apgar Score: at 5 min:_______; (if less than 6) at 10 min:_______
Abnormal Conditions of the Newborn (check all that apply)
□Assisted ventilation required immediately following delivery
□Assisted ventilation required for more than six hours
□NICU admission
□Newborn given surfactant replacement therapy
□Antibiotics received by the newborn for suspected neonatal sepsis
□Seizure or serious neurologic dysfunction
□Significant birth injury (skeletal fracture(s), peripheral nerve injury, and/or soft tissue/solid organ hemorrhage which requires intervention)
Congenital Anomalies of the Newborn (check all that apply)
Was Infant Transferred within 24 hours of Delivery?
□No □ Yes, Specify Facility _________________
Is Infant Living at Time of Report?
□Yes □ No
Is Infant Being Breastfed at Discharge?
□Anencephaly
□Meningomyelocele/Spina bifida
□Cyanotic congenital heart disease
□Congenital diaphragmatic hernia
□Omphalocele
□Gastroschisis
□Cleft palate alone
□Down syndrome
□Karyotype confirmed
□Karyotype pending
□Suspected chromosomal disorder
Hepatitis B Immunization given?
□ Hypospadias
□ Cleft lip with or without Cleft palate
Filling out the Child Birth Certificate form in Texas is an essential step in ensuring that your new arrival has all necessary legal documentation for future use. This form is crucial for establishing your child's legal identity, citizenship, parentage, and for access to various services throughout their life. It is important to complete this form accurately to avoid costly and time-consuming corrections down the line. Follow these steps carefully to ensure that all information provided on the Texas Child Birth Certificate form is correct and complete.
After completing the form, review all information for accuracy and completeness to ensure that your child's birth certificate correctly reflects their birth details. The information provided on this form is vital for obtaining a certified birth certificate, which plays a crucial role in your child’s life for accessing various services and rights.
To obtain a certified copy of your baby’s birth certificate in Texas, you can visit the local registrar’s office in the city or county where your child was born. Another option is to request it from the Texas Vital Statistics office located in Austin, Texas. A certified birth certificate is a crucial legal document that will be needed for various purposes throughout your child's life, such as enrolling in school, applying for a passport, and accessing government services.
If you opted to apply for your baby’s social security number by indicating "Yes" on the birth certificate worksheet, the birth information will be forwarded to the Social Security Administration once the hospital submits it to the Texas Vital Statistics office. It generally takes 2-3 weeks for the Social Security Administration to process this information. Following this, the social security card should be mailed to the mother's address listed on the worksheet, typically within 4-6 weeks from submission.
If you have provided your Medicaid information on the birth certificate worksheet, this information will be sent to the Medicaid office immediately after the Texas Vital Statistics office receives the data from the hospital. Processing this information usually takes about 2-3 weeks. Once processed, an Infant Medicaid card will be dispatched to the address provided by the mother, and the whole process can take around 4-6 weeks to complete.
For unmarried parents wanting to include the father's name on the birth certificate, both parents must complete an Acknowledgment of Paternity (AOP) form. If the mother was married to someone other than the biological father within 300 days before the child's birth, a Denial of Paternity by the former husband is also required in addition to the AOP. This process legally establishes paternity and allows the father's name to be listed on the birth certificate, ensuring that both parents' rights and obligations are recognized.
Filling out a birth certificate, a document of significant importance, requires meticulous attention to detail. Particularly in Texas, the form known as the Mother’s Worksheet for Child’s Birth Certificate demands accuracy, as inconsistencies or errors can be difficult and costly to amend later on. Individuals often make several common mistakes during this process, each of which can hinder the smooth legal recognition and rights of the newborn. Here’s a look at ten of those potential pitfalls:
Being vigilant and double-checking each entry can save considerable time and prevent legal headaches. Ensuring that all information on the Child Birth Certificate Texas form is complete, accurate, and clearly printed is an investment in the child’s smooth legal journey through life.
When welcoming a new member into your family, myriad forms and documents become part of this significant life event, especially in Texas. Besides the Child Birth Certificate form, which serves as the first official acknowledgment of a child's existence by the state, several other documents play integral roles in ensuring the well-being and legal recognition of your newborn. Each document supports or complements the birth certificate in various ways, from affirming parentage to securing the child's rights and access to services.
These documents together with the Child Birth Certificate form a foundation for your child's legal and social identity, offering protection, security, and access to rights. Each has its place in the mosaic of legal and administrative steps necessary to ensure a smooth path for your child’s future. It is advisable for parents to familiarize themselves with each of these documents, understanding their purpose, and ensuring they are timely and accurately filed or obtained. As your family embarks on this joyous phase, being well-prepared with the necessary paperwork can help ease the transition into parenthood.
A document similar to the Child Birth Certificate Texas form is the Passport Application form. Both documents play pivotal roles in verifying an individual's identity and citizenship. Like the birth certificate, a passport application requires detailed personal information, including full name, date, and place of birth. Both forms serve as foundational legal documents, the former establishing a person's existence and rights within a country, while the latter enables international travel by certifying the holder's nationality and identity to foreign governments. Additionally, both documents necessitate accuracy and completeness due to their legal importance, with any errors in information being difficult to amend and potentially leading to significant complications.
The Social Security Number (SSN) Application form shares similarities with the Child Birth Certificate Texas form in its purpose and importance for legal identification. The SSN application requests detailed personal information and establishes a unique identifier for individuals within the United States, which is used for a wide range of purposes, from tax filing to accessing government services. Like a birth certificate, obtaining an SSN is a crucial step in legitimizing an individual’s civil presence and facilitating their participation in social, economic, and political life. Both documents act as key entries into the citizenry's official records, enabling access to benefits and responsibilities.
Another similar document is the Marriage Certificate application. This form, like the birth certificate, confirms a significant life event and serves as official proof of that event. Both documents are vital records, kept and issued by government authorities, that certify the facts of a birth and a marriage, respectively. They are used throughout a person's life to access legal rights, benefits, and services. The information provided on both forms, such as names, dates, and places of birth, is crucial for legal identification purposes, further linking the two in their functional roles within personal and legal documentation.
Lastly, the Driver's License Application form has notable similarities with the Child Birth Suite Texas form. Both are essential for identification and certify the holder's qualification for certain rights; the birth certificate establishes identity and citizenship, while the driver's license certifies the right to operate a vehicle. Personal information, including full name and date of birth, is crucial for both documents. They are also both used as standard forms of identification for various purposes beyond their primary functions, such as proof of age and residency verification, underscoring their importance in an individual’s official and legal documentation portfolio.
When completing the Child Birth Certificate form for Texas, it’s important to keep in mind several crucial guidelines to ensure the process is carried out accurately and efficiently. The following lists highlight the dos and don’ts during this important process:
By following these guidelines, the process of completing the Child Birth Certificate Texas form can be straightforward, ensuring your child's vital information is recorded correctly from the start. Such proactive measures can help in avoiding any unnecessary complications or delays in using this document for various legal, educational, and medical purposes throughout your child's life.
Understanding the child birth certificate process in Texas is crucial for new parents. However, misconceptions can lead to confusion and errors. Here's a straightened-out list of some common misunderstandings:
Addressing these misconceptions helps ensure that parents are better prepared for the procedure of documenting their child's birth in Texas, laying a smoother path for their newborn's official documentation.
Filling out the Child Birth Certificate form in Texas is an important step in documenting a child's birth, as it serves several critical functions through the child's life.
Ensure Accuracy: It's crucial to print responses clearly and accurately on the form to avoid difficulties and expenses related to corrections later. The birth certificate is a legal document that confirms your child's age, citizenship, and parentage. Any errors can complicate future use for official purposes.
Understanding the importance of the Child Birth Certificate form can ease the process of securing your child's legal documents and benefits, such as medical or government services, passports, and school admissions. Take care to review all sections thoroughly and provide complete and accurate information as requested.
Remember, the birth certificate is your child's first official document and acts as the foundation for their legal identity in the state of Texas. Therefore, promptly and properly completing this form is not just a bureaucratic necessity but a crucial step in ensuring your child's access to rights and services.
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