Washington Application for Confidential Birth Information (DOH 422-081/ CHS 050)
Official state formOther requestsForm DOH 422-081/ CHS 050Free downloadLast verified November 10, 2026
Use this application to ask for certain items from the confidential section of your own Washington birth certificate, such as birth weight and Apgar scores. It is sent to the Center for Health Statistics at the Washington State Department of Health.
Who can use this form
- Only the person named on the birth certificate, for their own record
- You receive information about yourself only. Information about your mother or father stays restricted
What to send with it
- The completed application
- A government-issued ID showing your name, date of birth, photograph, signature and physical description
- Your notarized signature on the application, if you are not applying in person
- A copy of a legal document showing the change, if your name has changed since birth, such as a marriage certificate or a name change court order
Where to send it
- Mail to
- Center for Health Statistics P.O. Box 47814 Olympia, WA 98504-7814
- State fee
- Not provided
- Typical processing
- Not provided
- Form revision
- June 2010
- Source
- Official government page