Washington Application to Amend a Stillbirth or Fetal Death Certificate (DOH 422-313)
Official state formCorrections and amendmentsForm DOH 422-313Free downloadLast verified November 10, 2026
Use this application to fix or update a Washington certification of birth resulting in stillbirth or a fetal death certificate. It is mailed to the Center for Health Statistics at the Washington State Department of Health. It cannot change the cause, day or time of death.
Who can use this form
- A parent named on the certificate
- A sibling
- A grandparent
- Cause of death, injury, and day and time of death changes can only be requested by the medical certifier who signed the fetal death certificate
What to send with it
- Pages 3 and 4 of the application, filled out in blue or black ink
- A copy of a government-issued photo ID for every person who signs the application
- Supporting proof documents that show the full name and date of birth of the person whose information is being amended
- Proof that you qualify to ask for the amendment, if needed
- Optional: a certificate issued within the last year for a free exchange, or a certificate order form with payment
Where to send it
- Mail to
- Center for Health Statistics Attn: Amendments PO Box 47814 Olympia, WA 98504-7814
- State fee
- Not provided
- Typical processing
- 4 to 6 weeks, per the office's amendment page
- Form revision
- November 2026
- Source
- Official government page