health.ny.gov Fetal Death Certificate : New York Department

Name of the Organization : New York Department of Health
Type of Facility : Fetal Death Certificate
State : New York
Country : United States of America

Website : https://www.health.ny.gov/vital_records/fetal.htm
Application Form :  https://www.statusin.org/uploads/24404-doh.pdf

Fetal Death Certificate :

** For information about fetal deaths and stillbirths that occurred in New York City
** The New York State Department of Health does not file and cannot issue copies for these events if they occurred within the five boroughs of New York City.

Related : New York Department of Health Order a Marriage Certificate : www.statusin.org/24398.html

** For fetal deaths and still births that occurred in one of the five (5) boroughs of New York City (Manhattan, Brooklyn [Kings County], Queens, Bronx, and Staten Island [Richmond County]), please visit the New York City Department of Health and Mental Hygiene web site.

Fetal death is defined in New York State Public Health Law §4160 :
** Fetal death is defined as death prior to the complete expulsion or extraction from its mother of a product of conception;

** The death is indicated by the fact that after such separation, the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.

** In every case of a fetal death in New York State the death must be reported.
** If the death occurred in New York State outside of the five boroughs of New York City it is reported to the New York State Department of Health.

** This is done by authorized medical personnel or, in the case of a fetal death without medical attendance, by the coroner, medical examiner or medical director (in the case of Erie county).
** The fetal death must be reported regardless of the estimated gestational age of the fetus.

Who is eligible to obtain a copy of a fetal death certificate?
** A copy of the Fetal Death Certificate may be issued to the mother (patient) on the fetal death certificate.

What is the fee for a Fetal Death Certificate copy?
** There is no charge for the initial copy. Additional copies are $30.00 each.

How do I order a copy?
** If you are the mother on the record, you can use the Application for a Copy of a Fetal Death Certificate (DOH-3667) available as a PDF for download or by mail.
** The mother’s signature on the application must be notarized.

Application Forms by Mail :
** If you would prefer, we can mail a hardcopy of the form to you.
** Send a note with the name of the form you are requesting (i.e., “Fetal Death Certificate Application”), your name and your mailing address to

Address :
New York State Department of Health
Vital Records Still Birth Unit
P.O. Box 2602
Albany, NY 12220-2602