seriesNo,seriesEntityName,seriesTitle,seriesDateRange,seriesArrangement,seriesDescription,seriesTotRetentDesc,seriesPrimaryClassCode,seriesExtentDesc
11068,Davis County (Utah). Health Department. Administration Division,Death certificate,undated.,None,"These death certificates document all deaths occurring in the State of Utah as required by UCA 26-2-13 (1995). In 1905\, a state registry system of vital statistics was established at the State Health Department with local registrars. All certificates created before 1905 are only maintained at the local health department and prior to 1978 some local registrars may not have reported all deaths. Since 1978\, all originals are maintained at the State and copies at the local level. The information recorded includes the deceased's name\, gender\, date of birth\, race\, age\, county of death\, address\, birth place\, citizenship\, marital status\, name of spouse\, social security number\, occupation\, and parents' names; cause of death; if an autopsy was taken; if accident\, suicide\, or homicide caused death; place and time of death; disposition of the body; name and address of mortuary or crematory; and signature of person certifying death.",Retain permanently,Exempt,
10732,Davis County (Utah). Health Department. Administration Division,Local registrar report of certified copies issued,1987-,Chronological,"This is a monthly report on special fees collected by the local registrar from the purchase of birth and death certificates. A fee is collected for the Child Trust Fund when a person purchases the first certificate copy of a birth certificate. This fund is used for child abuse prevention and education (UCA_26-2-12.5 (1992)). An affidavit fee is collected to correct any birth or death certificate by amendment to the State Bureau of Vital Statistics. The report includes name of local registrar\,beginning and ending dates of report\, number of pages of paper stock used\, number of copies issued for initial copies of birth certificates\, multiple copies (birth) for birth certificates\, initial copies (death) certificates; multiple copies (death) long forms and totals\, multiple page copies short forms\, long forms and totals; voided copies\, birth cards\, short forms\, and long forms\, replacement copies; short forms\, long forms\, long forms\, and totals.",Retain for 4 year(s),Public,
10718,Davis County (Utah). Health Department. Administration Division,Monthly communicable disease summary report,1970-2010.,"Alphabetical by disease, thereunder chronological","These county forms report weekly and monthly statistics for diagnosed cases of each communicable disease in Davis County for a five year period. It is used locally for program planning purposes. The reports include communicable disease name\, number of reported cases per week\, per month\, yearly totals\, and five year totals.",Permanent. Retain for 1 year(s),Private,
10733,Davis County (Utah). Health Department. Administration Division,Mortuary death certificate invoices,1983-,Chronological,"These invoices are used to bill mortuaries for receiving certified death certificates. Mortuaries purchase multiple copies of certified death certificates at a discount rate and provide copies to the deceased's family. They include the date of service\, mortuary's name\, deceased's name\, and amount.",Retain for 4 year(s),Public,
12091,Davis County (Utah). Health Department. Administration Division,Systems and facilities billings,1987.,Alphabetical by facility name,"Billings sent to businesses to collect fees for various issued permits\, sent annually or biannually. They include date\, business name and address\, date payment due\, account number\, services provided and amount due\, total amount due\, date and amount paid and receipt number.",Retain for 5 year(s) after final action,Public,
10729,Davis County (Utah). Health Department. Administration Division,Father's paternity acknowledgment,undated.,None,"This state form is used by the father to acknowledge the paternity of a child when he is not married to the child's mother. The original form is retained by the State Health Department permanently. The form includes child's name\, birth date and place\, mother's name and address\, father's name and address\, and a notarized signed statement acknowledging child's paternity.",Permanent. Retain for 1 year(s),Private,
10716,Davis County (Utah). Health Department. Administration Division,Birth and death control card,1973-2010.,"Alphabetical by name, thereunder chronological","These cards serve as an index to birth and death certificates. The birth card includes name\, certificate number\, parents' names\, child's name\, and birth date. The death card includes name\, death certificate number\, death date\, and birth date.",Permanent. Retain until superseded,Exempt,
10951,Davis County (Utah). Health Department. Administration Division,Mileage reimbursement,1980-2013.,Chronological,"These monthly report forms document the use of personal vehicles for business by Health Department employees. They are used to receive reimbursements for the usage. They include two forms-the Davis County mileage record and the expense voucher for mileage reimbursement. The mileage record includes the name\, division\, date\, destination\, beginning and ending odometer readings\, total mileage per trip\, and totals. The expense voucher includes name of person being reimbursed\, department\, account number\, month\, total mileage\, total miles being reimbursed\, cost per mile\, total reimbursement\, employee's signature\, and department head's approval.",Retain for 3 year(s),Public,
11066,Davis County (Utah). Health Department. Administration Division,Board member application,1980-2000.,None,"This is an application used to apply for a position on the local board of health. All applications are retained for two years to create a pool for possible future openings. The form includes name\, address\, business and home telephone numbers\, education and work experience in health and environmental fields\, volunteer experience\, reasons for wanting to serve on board\, occupation\, signature and date.",Retain for 2 year(s),Public,
18963,Davis County (Utah). Health Department. Administration Division,Insurance billing records,1997-2018.,Alphabetical by patient's name,"This worksheet is used to bill insurance companies\, Medicaid Aging waiver\, and New Choice waiver. It includes date of service\, patient information (name\, address\, telephone number\, sex\, date of birth\, sex\, and social security number); insurance information (insurance company name\, subscriber's name\, policy number\, employer name); charges (code and amount); a listing of services\, code\, and charge (office procedures\, laboratory services\, immunizations and medications\, and perinatal services); diagnosis\, total charges\, and amount paid.",Retain for 1 year(s),Private,
11072,Davis County (Utah). Health Department. Administration Division,Veterans' death certificate application,1983-,"Chronological, thereunder alphabetical by name","This application is used by a veteran's next of kin to obtain a death certificate. One free certificate is available to veteran's next of kin for submission as evidence to the Veteran's Administration to receive a burial allowance and other veterans benefits. The application includes date\, deceased's name\, death date\, place of death\, name of war served and to whom application was issued.",Retain for 1 year(s),Public,
10721,Davis County (Utah). Health Department. Administration Division,Monthly nursing home death report,undated,None,"This report is submitted by nursing homes and assisted living facilities reporting deaths that occurred during the previous month. This report is required by UCA 26-2-23(3) (1995). It is used to determine whether certificates have been received. The record is kept by the local health department. The information includes the month of the report\, the nursing home's (or assisted living facility) name\, death date\, deceased's name\, the age at death\, medical attendant's name\, and the name of the funeral home or funeral director.",Retain for 1 year(s),Public,
10646,Davis County (Utah). Health Department. Administration Division,Certified birth certificate application,1973-2019.,None,"This application form is used to request a certified birth certificate or birth card. It includes the name\, date of birth\, and city of birth of the individual whose birth certificate is being requested; the applicant's name\, address\, telephone number\, and relationship to the individual whose birth certificate is being requested; the name\, year\, and state of birth of the individual's parents; reason for the request; request date; and the number of copies of the birth certificate or card requested.",Retain for 1 year(s),Private,
10720,Davis County (Utah). Health Department. Administration Division,Monthly hospital death report,undated,None,"This report is submitted monthly by all hospitals reporting all deaths\, fetal deaths\, or abortions that occurred during the month. It is required by UCA 26-2-23(3) (1995) and is used to ensure that all death certificates are filed. The report is maintained by the local health department. The form includes the month being reported\, hospital's name and location\, a list of deaths giving the date of death\, the name and age of the deceased\, the name of the medical attendant\, and the name of the funeral home or funeral director.",Retain for 1 year(s),Public,
10717,Davis County (Utah). Health Department. Administration Division,Certified death certificate application,1973-2019.,None,"This application is used to request a certified death certificate. It includes identifying information\, death date\, deceased's name\, place of death\, county birthplace of decedent\, usual residence of decedent\, name of father\, mother\, reason for requesting including relationship to person whose certificate is requested\, signature of applicant\, address\, phone\, date\, number requested\, and fee amount.",Retain for 1 year(s) after expiration of permit or license,Private,
25913,Davis County (Utah). Health Department. Administration Division,Voluntary declaration of paternity information forms,2004-,Chronological by date.,"County health departments use voluntary declaration of paternity/father information forms to add father information to birth certificate applications completed by mothers who were not married at the time of giving birth. The completed form is attached to the birth certificate application\, and the information thereon is provided to the Utah Office of Vital Records and Statistics (which maintains the record copy as series 81412). Voluntary declaration forms are completed voluntarily and sometimes are completed after DNA testing.",Retain until final action,Private,
10723,Davis County (Utah). Health Department. Administration Division,Monthly cemetery death report,undated,None,"This report lists all interments and is prepared monthly by all cemeteries in the state and submitted to their local health department as required by UCA 26-2-18(3) (1995). The information is used by the department to verify that all death certificates are being received. The original is retained by the local health department. The form includes the month and year\, name and location of the cemetery\, death date\, deceased's name and age\, the county where death occurred\, and the name of the funeral home or funeral director.",Retain for 1 year(s),Public,
10715,Davis County (Utah). Health Department. Administration Division,Board of Health meeting materials and minutes,1967-,Chronological.,"These meeting materials minutes document the actions of the local boards of health. Each local health department is required to have a board of health ""appointed by the local governing body and shall consist of at least three five persons"" (UCA 26A-1-109 (1995)). The Board of Health is responsible for establishing policy and \, for adopting regulations relating to the protection and promotion of public and environmental health health protection and the promotion of public health or environmental health. including but not limited to public health administration and support services\, maternal and child health\, communicable disease control\, surveillance and epidemiology\, food protection\, solid waste management\, wastewater management and safe drinking water management. They include the agenda\, notices\, and any public materials distributed at the meeting. and the actual minutes of proceedings of special and regular meetings of the local Boards of Health.",Retain permanently,Public,