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Delegate Cosgrove's bill provides for no modification of this form when women report fetal deaths themselves. The report requires the following items for spontaneous fetal deaths: place of occurrence usual residence of patient (mother) full maiden name of patient medical record number and social security number of patient blowjobs Hispanic origin, if blowjobs any, and race of patient age of patient education of patient blowjobs sex of fetus patient married to father previous deliveries to patient single or plural delivery and order of plural delivery date of delivery date of last normal menses and physician's estimate of gestation weight of fetus in grams month of pregnancy care began (sic) number of prenatal visits when fetus died congenital malformations, if any events of labor and delivery medical history for this pregnancy other history for this pregnancy obstetric procedures and method of delivery autopsy medical certification f cause of spontaneous fetal death signature of attending physician or medical examiner including title, address and date signed method of disposal
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