APPENDIX 4.—THE MODEL LAW.

Copies of this "Model Law," printed in large type, in the usual form in which bills are arranged and printed for the use of members of legislatures, etc., can be had by addressing the Secretary of the Council on Health and Public Instruction, American Medical Association, 535 North Dearborn Street, Chicago, Ill.

[NOTE. Before introducing this bill in any legislature, it should be carefully redrafted by a competent lawyer and submitted to the Bureau of the Census for criticism.]

A BILL TO PROVIDE FOR THE REGISTRATION OF ALL BIRTHS AND DEATHS IN THE STATE OF

[NOTE.-After the bill has been prepared for presentation to the legislature of a state, the title should be carefully revised by competent legal authority.]

Be it enacted by the Legislature of the State of·

SECTION 1.-That the State Board of Health shall have charge of the registration of births and deaths; shall prepare the necessary instructions, forms and blanks for obtaining and preserving such records and shall procure the faithful registration of the same in each primary registration district as constituted in Section 3 of this Act, and in the central bureau of vital statistics at the capital of the state. The said board shall be charged with the uniform and thorough enforcement of the law throughout the state, and shall from time to time recommend any additional legislation 1 that maybe necessary for this purpose.

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SEC. 2. That the secretary of the State Board of Health shall have general supervision over the central bureau of vital statistics, which is hereby authorized to be established by said board, and which shall be under the immediate direction of the state registrar of vital statistics, whom the State Board of Health shall appoint within thirty days after the taking effect of this law, and who shall be a medical practitioner of not less than five years' practice in his profession, and a competent vital statistician. The state registrar of vital statistics shall hold office for four years and until his successor has been appointed and has qualified, unless such office shall sooner become vacant by death, disqualification, operation of law, or other causes. Any vacancy occurring in such office shall be filled for the unexpired term by the State Board of Health. At least ten days before the expiration of the term of office of the state registrar of vital statistics, his successor shall be appointed by the State Board of Health. The state registrar of vital statistics shall receive an annual salary at the rate of dollars from the date of his entering upon the discharge of the duties of his office. The State Board of Health shall provide for such clerical and other assistants as may be necessary for the purposes of this Act, who shall serve during the pleasure of the board, and shall fix the compensation of persons thus employed within the amount appropriated therefor by the legislature. The custodian of the capitol shall provide for the bureau of vital statistics in the state capitol at suitable offices, which shall be properly

1 The words "and shall promulgate any additional rules or regulations" may be inserted in bills prepared for states in which the State Board of Health has power to make rules and regulations having the effect of law

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equipped with fireproof vault and filing cases for the permanent and safe preservation of all official records made and returned under this Act.

SEC. 3.-That for the purposes of this Act the state shall be divided into registration districts as follows: Each city, each incorporated town, and each township1 shall constitute a primary registration district; provided, that the State Board of Health may combine two or more primary registration districts when necessary to facilitate registration.

SEC. 4. That within ninety days after the taking effect of this Act, or as soon thereafter as possible, the State Board of Health shall appoint a local registrar of vital statistics for each registration district in the state. The term of office of each local registrar so appointed shall be four years, and until his successor has been appointed and has qualified, unless such office shall sooner become vacant by death, disqualification operation of law, or other causes; provided, that in cities where health officers or other officials are, in the judgment of the State Board of Health, conducting effective registration of births and deaths under local ordinances at the time of the taking effect of this Act, such officials may be appointed as registrars in and for such cities, and shall be subject to the rules and regulations of the state registrar, and to all of the provisions of this Act. Any vacancy occurring in the office of local registrar of vital statistics shall be filled for the unexpired term by the State Board of Health. At least ten days before the expiration of the term of office of any such local registrar, his successor shall be appointed by the State Board of Health.

Any local registrar who, in the judgment of the State Board of Health, fails or neglects to discharge efficiently the duties of his office as set forth in this Act, or to make prompt and complete returms of births and deaths as required thereby, shall be forthwith removed by the State Board of Health, and such other penalties may be imposed as are provided under Section 22 of this Act.

Each local registrar shall, immediately upon his acceptance of appointment as such, appoint a deputy, whose duty it shall be to act in his stead in case of his absence or disability; and such deputy shall in writing accept such appointment, and be subject to all rules and regulations governing local registrars. And when it appears necessary for the convenience of the people in any rural district, the local registrar is hereby authorized, with the approval of the state registrar, to appoint one or more suitable persons to act as subregistrars, who shall be authorized to receive certificates and to issue burial or removal permits in and for such portions of the district as may be designated; and each subregistrar shall note, on each certificate, over his signature, the date of filing, and shall forward all certificates to the local registrar of the district within ten days, and in all cases before the third day of the following month; provided, that each subregistrar shall be subject to the supervision and control of the state registrar, and may be by him removed for neglect or failure to perform his duty in accordance with the provisions of this Act or the rules and regulations of the state registrar, and shall be subject to the same penalties for neglect of duty as the local registrar. SEC. 5. That the body of any person whose death occurs in this state, or which shall be found dead therein, shall not be interred, deposited in a vault or tomb, cremated or otherwise disposed of, or removed from or into any registration district, or

1 Or other primary political unit, as "town," "precinct," "civil district," "hundred," etc. When there are no such units available the following substitutes for Section 3 may be employed: Section 3. That for the purposes of this Act the state shall be divided into registration districts as follows: Each city and each incorporated town shall constitute a primary registration district; and for that portion of each county outside of the cities and incorporated towns therein the State Board of Health shall define and designate the boundaries of a sufficient number of rural registration districts, which districts it may change or combine from time to time as may be necessary to insure the convenience and completeness of registration. 2 This method of appointment of local registrars by the State Board of Health-or perhaps by the state registrar or upon his nomination-with a reasonably long term of service and subject to removal for neglect of duty, is the preferable one for efficient service. Should there be objection, however, to the creation of new offices, the section may be redrafted so that it will provide that township, village, or city clerks, or other suitable officials, shall be the local registrars.

be temporarily held pending further disposition more than 72 hours after death, unless a permit for burial, removal, or other disposition thereof shall have been properly issued by the local registrar of the registration district in which the death occurred or the body was found.1 And no such burial or removal permit shall be issued by any registrar until, wherever practicable, a complete and satisfactory certificate of death has been filed with him as hereinafter provided; provided, that when a dead body is transported from outside the state into a registration district in for burial, the transit or removal permit, issued in accordance with the law and health regulations of the place where the death occurred, shall be accepted by the local registrar of the district into which the body has been transported for burial or other disposition, as a basis upon which he may issue a local burial permit; he shall note upon the face of the burial permit the fact that it was a body shipped in for interment, and give the actual place of death; and no local registrar shall receive any fee for the issuance of burial or removal permits under this Act other than the compensation provided in Section 20.

SEC. 6. That a stillborn child shall be registered as a birth and also as a death, and separate certificates of both the birth and the death shall be filed with the local registrar, in the usual form and manner, the certificate of birth to contain in place of the name of the child, the word "stillbirth"; provided, that a certificate of birth and a certificate of death shall not be required for a child that has not advanced to the fifth month of uterogestation. The medical certificate of the cause of death shall be signed by the attending physician, if any, and shall state the cause of death as "stillborn," with the cause of the stillbirth, if known, whether a premature birth, and, if born prematurely, the period of uterogestation, in months, if known; and a burial or removal permit of the prescribed form shall be required. Midwives shall not sign certificates of death for stillborn children; but such cases, and stillbirths occurring without attendance of either physician or midwife, shall be treated as deaths without medical attendance, as provided for in Section 8 of this Act.

SEC. 7.-That the certificate of death shall contain the following items, which are hereby declared necessary for the legal, social, and sanitary purposes subserved by registration records.2

(1) Place of death, including state, county, township, village, or city. If in a city, the ward, street, and house number; if in a hospital or other institution, the name of the same to be given instead of the street and house number. If in an industrial camp, the name of the camp to be given.

(2) Full name of decedent. If an unnamed child, the surname preceded by "Unnamed."

(3) Sex.

(4) Color or race—as white, black, mulatto (or other negro descent), Indian, Chinese, Japanese, or other.

(5) Conjugal condition- -as single, married, widowed, or divorced.

(6) Date of birth, including the year, month, and day.

(7) Age, in years, months and days. If less than one day, the hours or minutes. (8) Occupation. The occupation to be reported of any person, male or female, who had any remunerative employment, with the statement of (a) trade, profession, or particular kind of work; (b) general nature of industry, business, or establishment in which employed (or employer).

(9) Birthplace; at least state or foreign country, if known.

(10) Name of father.

(11) Birthplace of father; at least state or foreign country, if known.

(12) Maiden name of mother.

1 A special proviso may be required for sparsely settled portions of a state.

The following items are those of the United States standard certificate of death, approved by the Bureau of the Census.

(13) Birthplace of mother; at least state or foreign country, if known.

(14) Signature and address of informant.

(15) Official signature of registrar, with the date when certificate was filed, and registered number.

(16) Date of death, year, month, and day.

(17) Certification as to medical attendance on decedent, fact and time of death, time last seen alive, and the cause of death, with contributory (secondary) cause of complication, if any, and duration of each, and whether attributed to dangerous or insanitary conditions of employment; signature and address of physician or official making the medical certificate.

(18) Length of residence (for inmates of hospitals and other institutions; transients or recent residents) at place of death and in the state, together with the place where disease was contracted, if not at place of death, and former or usual residence. (19) Place of burial or removal; date of burial.

(20) Signature and address of undertaker or person acting as such.

The personal and statistical particulars (Items 1 to 13) shall be authenticated by the signature of the informant, who may be any competent person acquainted with the facts.

The statement of facts relating to the disposition of the body shall be signed by the undertaker or person acting as such.

The medical certificate shall be made and signed by the physician, if any, last in attendance on the deceased, who shall specify the time in attendance, the time he last saw the deceased alive, and the hour of the day at which death occurred. And he shall further state the cause of death, so as to show the course of disease or sequence of causes resulting in the death, giving first the name of the disease causing death (primary cause), and the contributory (secondary) cause, if any, and the duration of each. Indefinite and unsatisfactory terms, denoting only symptoms of disease or conditions resulting from disease, will not be held sufficient for the issuance of a burial or removal permit; and any certificate containing only such terms, as defined by the state registrar, shall be returned to the physician or person making the medical certificate for correction and more definite statement. Causes of death which may be the result of either disease or violence shall be carefully defined; and if from violence, the means of injury shall be stated, and whether (probably) accidental, suicidal, or homicidal.1 And for deaths in hospitals, institutions, or of non-residents, the physician shall supply the information required under this head (Item 18), if he is able to do so, and may state where, in his opinion, the disease was contracted.

SEC. 8. That in case of any death occurring without medical attendance, it shall be the duty of the undertaker to notify the local registrar of such death, and when so notified the registrar shall, prior to the issuance of the permit, inform the local health officer and refer the case to him for immediate investigation and certification; provided, that when the local health officer is not a physician, or when there is no such official, and in such cases only, the registrar is authorized to make the certificate and return from the statement of relatives or other persons having adequate knowledge of the facts; provided, further, that if the registrar has reason to believe that the death may have been due to unlawful act or neglect, he shall then refer the case to the coroner or other proper officer for his investigation and certification. And the coroner or other proper officer whose duty it is to hold an inquest on the body of any deceased person, and to make the certificate of death required for a burial permit, shall state in his certificate the name of the disease causing death, or if from external causes, (1) the means of death; and (2) whether (probably) accidental, suicidal, or homicidal; and shall, in any case, furnish such information as may be required by the state registrar in order properly to classify the death.

1 In some states the question whether a death was accidental, suicidal, or homicidal must be determined by the coroner or medical examiner, and the registration law must be framed to harmonize.