Updated Form

Hospital Statement to Amend, Correct, or Delete a Birth Record

Reason for update

The Office of Vital Records (OVR) updated the Hospital Statement to Amend, Correct, or Delete a Birth Record to comply with Minnesota Department of Health forms guidelines and to make clear that:

• A birth registrar, supervisor or manager must complete the form (not the parent)
• In addition to requesting an amendment or correction on behalf of the parent, birth registrars may request OVR to
  • Update health information on a birth record at any time, for no fee
  • Delete a duplicate birth record

Changes

• Birth record information section renamed to Information to locate the birth record
  • Three fields for child’s name: first, middle, last
  • Three fields for mother’s name: first, middle, last
• Requester information section renamed to HOSPITAL birth registrar, supervisor, or manager contact information
• Explanations after Correct, Amend and Delete options revised
• Requester signature renamed to Signature of hospital birth registrar, supervisor, or manager
• Payment information section makes clear that payment is for amendments only
  • New to the Payment information section: “Who is paying for the amendment?”
  • Check boxes provided to indicate who is paying for the amendment.

To whom does this apply?

Hospitals and hospital birth registrars

Effective date

Immediately

Actions

• Use the new form immediately.
• Delete your computer’s browsing history and refresh your shortcuts and links.
• Destroy old versions of the form.

Document (PDF & webpage)

Find the updated form on the Hospital Birth and Fetal Death Registration Forms webpage, and for your convenience, attached to this communication.

Contacts

Do you have questions?

Contact the Office of Vital Records at health.MRCAdmin@state.mn.us or 651-201-5993.

• hospstia.pdf