Monthly Count of Reports of Fetal Death
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Monthly Count of
Reports of Fetal Death
Registrar - Maintain a monthly count of the number of Reports of Fetal Death that were received
for each month. Send a copy of this form at the end of the year to: Vital Records Section
Registration Unit
New York State Department of Health
Empire State Plaza
Albany, New York 12237-0023.
YEAR
DISTRICT NUMBER
DISTRICT NAME
MONTH
NUMBER OF REPORTS OF
FETAL DEATH RECEIVED
FOR STATED MONTH
January
February
March
April
May
June
July
August
September
October
Novem ber
Decem ber
Total
NOTE: Reports of Fetal Death must be destroyed in a confidential manner by shredding or
burning within one month of their receipt, as required by Public Health Law 4170 (g).
DOH-2179 (4/93)