Ohio Admin. Code 3701-5-02 : — Department of Health - Administration and Director5 - Vital Statistics —5-02 - Forms used in the system of vital statistics

(A) The following forms, as set forth in the designated appendices to this rule, are prescribed for use in the system of vital statistics. Notwithstanding the requirement that the forms set forth below be used in the system of vital statistics, a mother's name and address and a father's name are not required to be entered on a fetal death report:
(1) Certificate of live birth (appendix A);
(2) Certificate of death (appendix B);
(3) Report of fetal death (appendix C);
(4) Affidavit correction of birth record (appendix D);
(5) Supplementary medical certification (appendix E);
(6) Certificate of service (appendix F);
(7) Burial-transit permit (appendix G);
(8) Certificate of adoption (appendix H);
(9) Affidavit requesting new birth certificate for adopted child (appendix I);
(10) Certified abstract of marriage (appendix J);
(11) Certified abstract of divorce, annulment, or dissolution (appendix K);
(12) Determination of paternity (appendix L);
(13) Affidavit to correct a death certificate or fetal death

report (appendix M);

(14) Application, finding, and order for correction of birth record (appendix N);
(15) Certification of birth record (recreation of birth facts) (appendix O);
(16) Finding and order establishing registration of birth (appendix P);
(17) Application, finding, and order for registration (appendix Q);
(18) Affidavit for adopted person requesting information for adoption file (appendix R);
(19) Medical birth information request (appendix S);
(20) Application for certified copy of birth or death certificate or paternity affidavit (appendix T);
(21) Application for certificate of public record (appendix U);
(22) Denial of release for biological parent (appendix V);
(23) Authorization for release form for biological parent (appendix W);
(24) Authorization of release of adopted name (appendix X);
(25) Rescission of authorization of release of adopted name (appendix Y);
(26) Certification of birth (appendix Z); and
(27) Certification of birth for a stillborn (appendix AA).
(B) To be registered, each vital record that is required to be filed under Chapter 3705. of the Revised Code shall comply with all of the following requirements, except as otherwise provided in that chapter:
(1) The record shall be prepared in a form approved or prescribed and distributed by the director;
(2) The record shall be prepared and completed in accordance with the written instructions prescribed and distributed by the director;
(3) The record shall contain all items of information requested thereon. If any such items are omitted, the person responsible for completion of the record shall satisfactorily account for their omission; and
(4) The record shall contain, in type or legible print, the certifier's name .
(C) All forms, certificates, and reports used in the system of vital statistics are the property of the Ohio department of health and shall be surrendered to the state registrar upon demand. The forms prescribed and distributed by the director for reporting vital statistics shall be used only for official purposes. Only those forms furnished or approved by the director shall be used in the reporting of vital statistics or in making copies thereof.

Ohio Admin. Code 3701-5-02

Five Year Review (FYR) Dates: 11/2/2021 and 11/02/2026
Promulgated Under: 119.03
Statutory Authority: 3705.24
Rule Amplifies: 3705.08, 3107.45, 3107.47, 3707.48
Prior Effective Dates: 11/20/1994, 05/03/1997, 12/01/2005, 01/01/2011, 07/03/2016
Effective: 7/3/2016
Five Year Review (FYR) Dates: 04/11/2016 and 04/01/2021
Promulgated Under: 119.03
Statutory Authority: 3705.02
Rule Amplifies: 3705.08, 3107.45, 3107.47, 3707.48
Prior Effective Dates: 11/20/1994, 5/3/97, 12/1/05, 1/1/11