AGENCY: Davis County (Utah). Health Department. Nursing Division

SERIES: 10797
TITLE: Sudden Infant Death Syndrome administrative data report
DATES: 1978-2010.
ARRANGEMENT: Chronological

DESCRIPTION: This report form is submitted to the State Sudden Infant Death Syndrome (SIDS) Program Office by the local health department within one month after a SIDS death in their jurisdiction. This report documents SIDs deaths and investigation results. The local health department maintains a copy to document that a report was filed. The form includes infant's name, office of medical examiner's number, parents' names, address, and telephone number, death date, birth date, infant's age, sex, and race, pediatrician's (or family physician's) name, county of death, funeral home name, pathologist's name, autopsy date, referral date, and name of person making referral, date of telephone referral, date referral mailed, parent's birth dates, occupations, and schooling, marital status, name of close friend or relative, name and address of initial telephone contact by a public health nurse, and date of initial home visit by public health nurse.

RETENTION

DISPOSITION

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

APPROVED: 12/1992

FORMAT MANAGEMENT

Paper copy: Retain in Office for 3 years and then destroy.

APPRAISAL

Administrative

This disposition is based on the administrative needs expressed by the local health department.

PRIMARY DESIGNATION

Private

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