Washington Fetal Death Certificate Order Form (DOH 422-183)
Official state formStillbirth and pregnancy lossForm DOH 422-183Free downloadLast verified November 10, 2026
Use this form to order a certified Washington fetal death certificate. Only qualified applicants can receive one. It is mailed with identity and eligibility documents and payment to the Center for Health Statistics at the Washington State Department of Health.
Who can use this form
- A parent, sibling or grandparent
- A parent's legal representative
- A representative named by a qualified applicant on the notarized DOH 422-186 form
- The funeral director or funeral establishment listed on the record, up to 12 months from the date of death
- A government agency or the courts, only for official duties
What to send with it
- The completed order form, signed and dated
- A copy of your identity document. Do not send originals
- A copy of your proof of eligibility document, if your identity document does not link you to the record
- A check or money order made payable to DOH. Certificate purchases are nonrefundable
- If you send the order with a correction request, the form gives a different address: Center for Health Statistics, Attn: Corrections, PO Box 47814, Olympia, WA 98504-7814
Where to send it
- Mail to
- Department of Health Center for Health Statistics PO Box 9709 Olympia, WA 98507
- State fee
- $25 per fetal death certificate; $15 per apostille. First class mail at no additional charge.
- Typical processing
- Not provided
- Form revision
- November 2025
- Source
- Official government page