St. Joseph County, MI · St. Joseph County
Facility Worksheet for Live Birth
This worksheet records details about a live birth and is completed by the attendant or other person reporting the birth.
At a glance
- Issued by
- City of St. Joseph County · St. Joseph County, St. Joseph County, Michigan
- Notarization
- Not required: file this form without a notary.
- Official source
- Original source unavailable. Use the archived PDF.
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
The Facility Worksheet for Live Birth records information about the child, birth parent, place of birth, prenatal care, labor and delivery, newborn health, and screening. It also requests the attendant’s name, title, NPI number, and the completing person’s signature. The document does not state when the county requires it or provide submission instructions.
Who needs it
An attendant or other person completing a live-birth report can use this worksheet to record the requested birth and newborn information.
How to submit it
Submit it to the county department named on the form; check the county website for current contact details.
About notarization
The form has no notary block; the completing person signs it, and no notarized attachment or sworn step is listed.
How to submit this form
- 1
Download the Worksheet
Download the Facility Worksheet for Live Birth PDF.
- 2
Complete the Worksheet
Enter the requested birth, delivery, newborn, attendant, and screening information.
- 3
Check for Attachments
The worksheet does not list any attachments.
- 4
Submit to the County
Submit it to the county department named on the form; check the county website for current contact details.
Frequently asked questions
- What information does the Facility Worksheet for Live Birth request?
- It requests details about the child, birth parent, place of birth, prenatal care, labor and delivery, newborn health, attendant, and screening.
- Who completes the live-birth worksheet?
- The worksheet includes fields for the attendant’s name, title, and NPI number, as well as the name and signature of the person completing the form.
- Do I need a notary for the Facility Worksheet for Live Birth?
- No. The worksheet has no notary block; the completing person signs it, and no notarized attachment or sworn step is listed.
- How do I submit the Facility Worksheet for Live Birth?
- The document does not provide submission instructions. Submit it to the county department named on the form; check the county website for current contact details.