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L-0.2, r. 1 - Regulation respecting the application of the Act respecting medical laboratories and organ and tissue conservation
Schedule
Disposition versions
SCHEDULE 1
(Revoked)
SCHEDULE 1
(ss. 9 and 14)
RETURN OF LIVE BIRTH
SP-1
Return of Live Birth
Please type or print in block letters using a ball-point pen.
Do not write in shaded spaces. Press firmly.
PLACE OF BIRTH
1. Name of institution where birth occurred
2. Code of institution
3. Exact location where birth occurred (No., street, municipality, province or country) Postal Code
IDENTIFICATION OF PARENTS (Write the surname and given names according to the act of birth)
FATHER
4. Surname of father
5. Usual given name
6. Birthdate of father
7. Age
8. Father’s birthplace (province or country)
9. Mother tongue of father
01 French
02 English Other
MOTHER
10. Surname of mother (according to the act of birth)
11. Usual given name
12. Tel. No. where mother can be reached
13. Birthdate of mother
14. Age
15. Mother’s birthplace (province or country)
16. Mother tongue of mother
01 French
02 English Other
17. Mother’s address (No., street, municipality, province or country) Postal Code
18. Language spoken at home
01 French
02 English
Other
19. Marital status of mother
1 Single (never married)
2 Married and living with her spouse
3 Widowed
4 Divorced
5 Legally separated
6 Separated, but not legally
20. Relationship with partner
1 Living together as a couple
2 Not living together as a couple
21. Number of years mother attended school
22. Number of children previously born (excluding present pregnancy)
liveborn
Stillborn (500 grams or more)
23. Date of last live birth
24. Date of last marriage
IDENTIFICATION OF CHILD AT BIRTH
25. Surname of child
26. Given name(s)
SIGNATURE OF MOTHER OR FATHER
I confirm that the above information is accurate, and authorize its being sent to the Bureau de la statistique du Québec, to the ministère de la Santé et des Services sociaux, to the regional public health department and to the local community service centre.
27. Date signed
28. Signature of at least one of the two parents
MEDICAL CERTIFICATION OF BIRTH
29. Date and time of birth
Year
Month
Day
Hour
Minute
30. Type of birth
01 Single
02 Twin
31. If multiple birth, state whether this child born
1st
2nd
3rd
Other (specify)
32. Sex of child
1 Male
2 Female
9 Undetermined
33. Weight at birth (grams)
34. Duration of pregnancy (completed weeks)
35. Accoucheur (surname and usual given name)
36. Permit No. (Corp. des médecins)
37. Tel No. at work
38. Accoucheur’s address (No., street, municipality, province) Postal code
39. Was the accoucheur a
1 Physician
2 Nurse
Other (specify)
40. Signature of accoucheur
41. Date signed
The information given is subject to the provisions of the Act respecting Access to documents held by public bodies and the Protection of personal information. The conditions are listed on the back of this copy.
In the case of a multiple birth, please fill in a Return of Live Birth (SP-1) for each liveborn child and a Return of Stillbirth (SP-4) for each stillborn child.
If a child dies immediately after birth or during the days that follow, a Return of Live Birth (SP-1) and a Return of Death (SP-3) must nevertheless be completed.
SP-1 (93-11)
1-0000001
BUREAU DE LA STATISTIQUE DU QUÉBEC
Return of Live Birth
Please type or print in block letters using a ball-point pen.
Do not write in shaded spaces. Press firmly.
PLACE OF BIRTH
1. Name of institution where birth occurred
2. Code of institution
3. Exact location where birth occurred (No., street, municipality, province or country) Postal Code
IDENTIFICATION OF PARENTS (Write the surname and given names according to the act of birth)
FATHER
4. Surname of father
5. Usual given name
6. Birthdate of father
7. Age
8. Father’s birthplace (province or country)
9. Mother tongue of father
01 French
02 English Other
MOTHER
10. Surname of mother (according to the act of birth)
11. Usual given name
12. Tel. No. where mother can be reached
13. Birthdate of mother
14. Age
15. Mother’s birthplace (province or country)
16. Mother tongue of mother
01 French
02 English Other
17. Mother’s address (No., street, municipality, province or country) Postal Code
18. Language spoken at home
01 French
02 English
Other
19. Marital status of mother
1 Single (never married)
2 Married and living with her spouse
3 Widowed
4 Divorced
5 Legally separated
6 Separated, but not legally
20. Relationship with partner
1 Living together as a couple
2 Not living together as a couple
21. Number of years mother attended school
22. Number of children previously born (excluding present pregnancy)
liveborn
Stillborn (500 grams or more)
23. Date of last live birth
24. Date of last marriage
IDENTIFICATION OF CHILD AT BIRTH
25. Surname of child
26. Given name(s)
SIGNATURE OF MOTHER OR FATHER
I confirm that the above information is accurate, and authorize its being sent to the Bureau de la statistique du Québec, to the ministère de la Santé et des Services sociaux, to the regional public health department and to the local community service centre.
27. Date signed
28. Signature of at least one of the two parents
MEDICAL CERTIFICATION OF BIRTH
29. Date and time of birth
Year
Month
Day
Hour
Minute
30. Type of birth
01 Single
02 Twin
31. If multiple birth, state whether this child born
1st
2nd
3rd
Other (specify)
32. Sex of child
1 Male
2 Female
9 Undetermined
33. Weight at birth (grams)
34. Duration of pregnancy (completed weeks)
35. Accoucheur (surname and usual given name)
36. Permit No. (Corp. des médecins)
37. Tel No. at work
38. Accoucheur’s address (No., street, municipality, province) Postal code
39. Was the accoucheur a
1 Physician
2 Nurse
Other (specify)
40. Signature of accoucheur
41. Date signed
The information given is subject to the provisions of the Act respecting Access to documents held by public bodies and the Protection of personal information. The conditions are listed on the back of this copy.
In the case of a multiple birth, please fill in a Return of Live Birth (SP-1) for each liveborn child and a Return of Stillbirth (SP-4) for each stillborn child.
If a child dies immediately after birth or during the days that follow, a Return of Live Birth (SP-1) and a Return of Death (SP-3) must nevertheless be completed.
SP-1 (93-11)
1-0000001
BUREAU DE LA STATISTIQUE DU QUÉBEC
Pursuant to sections 64 and 65 of the Act respecting Access to documents held by public bodies and the Protection of personal information (chapter A-2.1)
Please note that:
(1) The information contained in the Return of Live Birth is gathered on behalf of the Bureau de la statistique du Québec (117, rue Saint-André, Québec), the ministère de la Santé et des Services sociaux (1075, chemin Sainte-Foy, Québec), the regional public health department and the local community service centre.
(2) The information gathered for the Bureau de la statistique du Québec is used for administrative and statistical purposes. The information transmitted to the ministère de la Santé et des Services sociaux is included in the birth file used in planning, managing, controlling and assessing programs. The copy of the Return of Live Birth sent to the regional public health department and to the local community service centre is used in planning public and community health services.
(3) This information will be accessible to:
· employees of the Bureau de la statistique du Québec, the ministère de la Santé et des Services sociaux, the regional public health department and the local community service centre within the context of their work;
· any other user meeting the requirements of the Act referred to in the heading and of the Public Health Protection Act (chapter P-35).
(4) Sections 83 to 102 of the Act referred to in the heading provide for a right of access to the information contained in this form and the right to have the information corrected if it is inaccurate, incomplete or equivocal.
(5) The information requested in this return is mandatory. However, if the child’s parents are not married and the return is signed by the mother only, the mother is not required to indicate the surname and given name of the father.
(6) The Public Health Protection Act provides for penalties in the case of a false declaration or of a refusal to supply the requested information.
RETURN OF LIVE BIRTH
SP-1
Return of Live Birth
PLACE OF BIRTH
1. Name of institution where birth occurred
2. Code of institution
3. Exact location where birth occurred (No., street, municipality, province or country) Postal Code
IDENTIFICATION OF PARENTS (Write the surname and given names according to the act of birth)
FATHER
4. Surname of father
5. Usual given name
6. Birthdate of father
7. Age
8. Father’s birthplace (province or country)
9. Mother tongue of father
01 French
02 English Other
MOTHER
10. Surname of mother (according to the act of birth)
11. Usual given name
12. Tel. No. where mother can be reached
13. Birthdate of mother
14. Age
15. Mother’s birthplace (province or country)
16. Mother tongue of mother
01 French
02 English Other
17. Mother’s address (No., street, municipality, province or country) Postal Code
18. Language spoken at home
01 French
02 English
Other
19. Marital status of mother
1 Single (never married)
2 Married and living with her spouse
3 Widowed
4 Divorced
5 Legally separated
6 Separated, but not legally
20. Relationship with partner
1 Living together as a couple
2 Not living together as a couple
21. Number of years mother attended school
22. Number of children previously born (excluding present pregnancy)
liveborn
Stillborn (500 grams or more)
23. Date of last live birth
24. Date of last marriage
IDENTIFICATION OF CHILD AT BIRTH
25. Surname of child
26. Given name(s)
SIGNATURE OF MOTHER OR FATHER
I confirm that the above information is accurate, and authorize its being sent to the Bureau de la statistique du Québec, to the ministère de la Santé et des Services sociaux, to the regional public health department and to the local community service centre.
27. Date signed
28. Signature of at least one of the two parents
MEDICAL CERTIFICATION OF BIRTH
29. Date and time of birth
Year
Month
Day
Hour
Minute
30. Type of birth
01 Single
02 Twin
31. If multiple birth, state whether this child born
1st
2nd
3rd
Other (specify)
32. Sex of child
1 Male
2 Female
9 Undetermined
33. Weight at birth (grams)
34. Duration of pregnancy (completed weeks)
35. Accoucheur (surname and usual given name)
36. Permit No. (Corp. des médecins)
37. Tel No. at work
38. Accoucheur’s address (No., street, municipality, province) Postal code
39. Was the accoucheur a
1 Physician
2 Nurse
Other (specify)
40. Signature of accoucheur
41. Date signed
The information given is subject to the provisions of the Act respecting Access to documents held by public bodies and the Protection of personal information. The conditions are listed on the back of this copy.
In the case of a multiple birth, please fill in a Return of Live Birth (SP-1) for each liveborn child and a Return of Stillbirth (SP-4) for each stillborn child.
If a child dies immediately after birth or during the days that follow, a Return of Live Birth (SP-1) and a Return of Death (SP-3) must nevertheless be completed.
SP-1 (93-11)
1-0000001
BUREAU DE LA STATISTIQUE DU QUÉBEC
LOCAL COMMUNITY SERVICE CENTRE
Return of Live Birth
PLACE OF BIRTH
1. Name of institution where birth occurred
2. Code of institution
3. Exact location where birth occurred (No., street, municipality, province or country) Postal Code
IDENTIFICATION OF PARENTS (Write the surname and given names according to the act of birth)
FATHER
4. Surname of father
5. Usual given name
6. Birthdate of father
7. Age
8. Father’s birthplace (province or country)
9. Mother tongue of father
01 French
02 English Other
MOTHER
10. Surname of mother (according to the act of birth)
11. Usual given name
12. Tel. No. where mother can be reached
13. Birthdate of mother
14. Age
15. Mother’s birthplace (province or country)
16. Mother tongue of mother
01 French
02 English Other
17. Mother’s address (No., street, municipality, province or country) Postal Code
18. Language spoken at home
01 French
02 English
Other
19. Marital status of mother
1 Single (never married)
2 Married and living with her spouse
3 Widowed
4 Divorced
5 Legally separated
6 Separated, but not legally
20. Relationship with partner
1 Living together as a couple
2 Not living together as a couple
21. Number of years mother attended school
22. Number of children previously born (excluding present pregnancy)
liveborn
Stillborn (500 grams or more)
23. Date of last live birth
24. Date of last marriage
IDENTIFICATION OF CHILD AT BIRTH
25. Surname of child
26. Given name(s)
SIGNATURE OF MOTHER OR FATHER
I confirm that the above information is accurate, and authorize its being sent to the Bureau de la statistique du Québec, to the ministère de la Santé et des Services sociaux, to the regional public health department and to the local community service centre.
27. Date signed
28. Signature of at least one of the two parents
MEDICAL CERTIFICATION OF BIRTH
29. Date and time of birth
Year
Month
Day
Hour
Minute
30. Type of birth
01 Single
02 Twin
31. If multiple birth, state whether this child born
1st
2nd
3rd
Other (specify)
32. Sex of child
1 Male
2 Female
9 Undetermined
33. Weight at birth (grams)
34. Duration of pregnancy (completed weeks)
35. Accoucheur (surname and usual given name)
36. Permit No. (Corp. des médecins)
37. Tel No. at work
38. Accoucheur’s address (No., street, municipality, province) Postal code
39. Was the accoucheur a
1 Physician
2 Nurse
Other (specify)
40. Signature of accoucheur
41. Date signed
The information given is subject to the provisions of the Act respecting Access to documents held by public bodies and the Protection of personal information. The conditions are listed on the back of this copy.
In the case of a multiple birth, please fill in a Return of Live Birth (SP-1) for each liveborn child and a Return of Stillbirth (SP-4) for each stillborn child.
If a child dies immediately after birth or during the days that follow, a Return of Live Birth (SP-1) and a Return of Death (SP-3) must nevertheless be completed.
SP-1 (93-11)
1-0000001
BUREAU DE LA STATISTIQUE DU QUÉBEC
LOCAL COMMUNITY SERVICE CENTRE
General instructions concerning the Return of Live Birth (SP-1) intended for the Bureau de la statistique du Québec
The Return of Live Birth is used in compliance with the regulations made under the Public Health Protection Act (chapter P-35). Pursuant to that Act, the Minister of Health and Social Services has the power to establish and maintain a system for gathering and analysing social, medical and epidemiological data and compile information on births, marriages, divorces, annulments and deaths for demographic purposes. The Bureau de la statistique du Québec is responsible for gathering, processing and using this data under Order in Council 260-85, dated 12 February 1985.
Preliminary notes
· In all cases where the name of a municipality is requested in an address, the full name of the municipality must be given, not that of the region or of a neighbouring city or town, which might be better known.
Examples:
(1) Name of municipality: Montréal-Nord
Not Montréal but Montréal-Nord
(2) Name of municipality: Sainte-Victoire-d’Arthabaska
Not Arthabaska but Sainte-Victoire-d’Arthabaska
· Care should be taken to fill in dates and numbers in the appropriate squares. Mark one zero in each empty space to the left of a figure to show that the figure is complete. All questions must be answered; if the number is zero, mark zero in the appropriate square(s); if the question is not applicable, draw a horizontal line through the appropriate square(s). Note that all dates should be entered in the following sequence: year, month, day.
Examples:
Stillbirth |0|0|; June 2, 1958 |5|8|0|6|0|2| 524 grams |0|5|2|4|
· The answers must always reflect the situation at the time of the birth, such as the mother’s home address, marital status, etc.
DISTRIBUTION OF FORMS
Bureau de la statistique du Québec
117, rue Saint-André
Québec (Québec)
G1K 3Y3
TIME LIMIT FOR MAILING FORMS
A time limit of eight (8) days after the birth is prescribed for mailing the Return of Live Birth (page 1-SP-1) to the Bureau de la statistique du Québec. The Return of Live Birth must be sent to the Bureau de la statistique du Québec even if the parents have not decided on the child’s surname and given names.
ROLE OF THE INSTITUTION
The institution must send page 1 of the form to the Bureau de la statistique du Québec and page 4 to the regional public health department.
Questions 4, 5 and 11
Usual given name of father and mother and surname of father
Enter the given name ordinarily used, which mentioned in the act of birth. Compound given names, such as Jean-Pierre or Marie-Claude, must be hyphenated. Do not use nicknames. Even if the father’s name is not indicated by the mother is questions 4 and 5, his characteristics (age, date and place of birth, mother tongue) must still be given, if known.
Mother tongue of father and mother
This refers to the first language acquired as a child and still understood. If the first language is no longer understood, give the second language acquired and still understood. If a person gives two answers, please insist that he or she select the language most often used in childhood.
Question 10
Surname of mother
This refers to the surname on the act of birth and not the spouse’s surname. Do not use nicknames.
Language spoken at home
If more than one language is spoken at home, give the one most frequently used. List one language only.
Questions 19 and 20
Marital status of mother and relationship with partner
When a mother states that she is separated, it must be ascertained whether or not she is legally separated. The notion of relationship with partner is left undefined so that the parents may answer according to their own perception. Questions 19 and 20 must be answered, regardless of the marital status of the parents.
Question 21
Number of years of schooling
This refers to the number of years of schooling successfully completed. School years that were not completed or for which a pass mark was not obtained at the end of the year should not be counted.
Question 22
Number of children born previously
This question must be answered in all cases with no exceptions. For women giving birth for the first time, enter zeros in all the appropriate spaces; for those who have given birth before, indicate the number of live births and, if applicable, the number of stillbirths.
Question 23
Date of last live birth
Enter the birth date of the preceding live birth. For women giving birth for the first time, draw a horizontal line though the appropriate square.
Question 24
Date of last marriage
For those who have been married only once, enter the date of that marriage; for those married more than once, enter the date of the most recent marriage.
Question 25
Surname of child
The surname of the child may be that of the father. Baker; that of the mother, Smith; or of both, Smith-Baker or Baker-Smith, in the latter case, the two surnames must be hyphenated. Initial, such as B.-Smith, may not be used.
Question 26
Child’s given names
One or more given names may be given to the child by the parents. However, it is recommended that the number of given names be limited to four (4), and that the given name ordinarily used be placed at the beginning of the list of given names. Compound given names, such as Jean-Pierre or Marie-Claude, must be hyphenated.
Question 28
Signature of parents
The signature of at least one of the two parents is required in order to prompt them to make sure that the information in the form is the information they provided. If both parents are dead or unable to sigh, the child’s next-of-kin must sign in their place.
Questions 30 and 31
Multiple birth
If possible, all the forms pertaining a multiple birth (SP-1, SP-3 or SP-4) should be stapled together.
Question 33
Birth weight
Weight should be given in grams only, never in kilograms.
Regional public health department
The copy of the Return of Live Birth (page 4) transmitted to the regional public health department and to the local community service centre is used in planning public or community health services.
