Indiana Certificate Of Live Birth Worksheet Template Page 12
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90. Was the mother transferred to this facility for maternal medical or fetal indications for delivery?
. Was the mother transferred to this facility for maternal medical or fetal indications for delivery?
90
90
. Was the mother transferred to this facility for maternal medical or fetal indications for delivery?
. Was the mother transferred to this facility for maternal medical or fetal indications for delivery?
(Transfers include hospital to hospital, birth facility to hospital, etc.)
Yes
No
If Yes, enter the name of the facility mother transferred from:
____________________________________________________________________________________
5/25/2012
PAGE 12
VERSION 27 INDIANA'S BIRTH WORKSHEET
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