The certificate of live birth is the Missouri Department of Health and Senior Services (DHSS) form, numbered VS 100C, on which a birth is reported for state registration. It records the child, the mother/co-parent, the father/co-parent, the certifier and the attendant, and it includes confidential and medical sections marked for internal use only. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the original form is published by the DHSS at health.mo.gov.
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What is VS 100C?
Form VS 100C, Certificate of Live Birth (MO 580-0697), is the Missouri Department of Health and Senior Services form on which a child's birth, parents, certifier and medical and health information are recorded for state registration.
The form carries a State File Number at the top and ends its first block with a "Vital Records Use Only" area where the registrar signs and enters the date filed (item 16). The rest is organized as follows:
- Items 1 to 8: the child's name, date and time of birth, sex, and the city, county, type of place and facility of birth.
- Items 9 to 12: the mother's/co-parent's names, birth data, residence and mailing address, and the father's/co-parent's name, date of birth and birthplace.
- Items 13 to 15: the certifier's and the attendant's names, titles, Missouri license numbers and NPI numbers, and the certifier's statement that the child was born alive.
- An Affirmation of Birth block with printed names, signatures, addresses and a notary section.
- Items 17 to 39: information the form marks as confidential and for internal use only, such as marital status, Social Security numbers, education, ethnicity, race, prenatal care and smoking history.
- Items 40 to 47 (medical and health information) and items 48 to 61 (newborn information), also marked confidential.
The Bureau of Vital Records page on delayed birth registration describes a different procedure: a person who is now 12 or older, was born in Missouri and has no registered birth certificate uses separate affidavits and supporting documents. That procedure is not part of this form.
Who needs to file VS 100C?
The people who complete this form are those involved in the birth. The certifier named in item 13 certifies that the child was born alive; the form lists MD, DO, CNM/CM, CPM, other midwife, hospital administrator or other (specify) as the certifier's title. The attendant in item 14 is identified with the same titles, and a box lets you mark "Same as certifier above" when one person fills both roles.
The mother/co-parent supplies the information about herself in items 9 to 11 and the confidential items directed to her, such as marital status (18a), education (21), Hispanic origin (22) and race (23). Items 24 to 26 ask the same education, origin and race questions about the father/co-parent. Item 17 records whether permission is given to provide the Social Security Administration with the birth information needed to issue a Social Security number.
The Affirmation of Birth block provides spaces for two persons to print their names, sign a declaration under penalty of perjury and give their addresses, with a notary public completing the final section.
This form is not the delayed birth registration process. A person born in Missouri who is 12 or older and has no registered birth certificate follows the separate instructions on the Bureau of Vital Records page, and the Bureau says a delayed birth certificate cannot be filed for a deceased person.
When to file VS 100C
The triggering event is the birth of a child: the certifier's statement at item 13d says the child was born alive at the place and time on the date stated, and the certifier enters the date signed at item 13e. No separate due date is printed on the form itself.
Complete the date-sensitive entries from the record of the birth: date and time of birth (items 2 and 3), the dates of the first and last prenatal care visits (28a and 28b), the date the last normal menses began (38) and, for a multiple birth, the order of birth (53a).
A person who was born in Missouri, is now 12 or older and has no registered birth certificate does not use this timing. The Bureau of Vital Records describes a delayed birth registration process on its page for that situation.
How to fill out VS 100C
Enter the child's name and birth details
Item 1: the child's first, middle and last name and suffix. Items 2 to 5: date of birth (month, day, year), time of birth with AM or PM, sex, and the city, town or location of birth.
Record the place of birth
Item 6: county of birth. Item 7: check one place (hospital, freestanding birthing center, home birth, clinic, doctor's office or other); for a home birth, answer whether delivery at home was planned. Item 8: facility name, or the number and street if it is not an institution.
Enter the mother's/co-parent's names
Item 9a: name prior to first marriage. Item 9b: date of birth. Item 9c: current legal name. Item 9d: birthplace, with country and state, territory or province.
Enter residence and mailing address
Item 10: the mother's/co-parent's residence (country, state, city, number and street, ZIP code, county) and whether it is inside city limits (Yes, No or Unknown). Item 11: mailing address, or check SAME AS RESIDENCE.
Enter the father's/co-parent's information
Item 12a: current legal name. Item 12b: date of birth. Item 12c: birthplace, with country and state, territory or province.
Complete the certifier section
Item 13a to 13c: the certifier's name, title (MD, DO, CNM/CM, CPM, other midwife, hospital administrator or other), Missouri license number and NPI number. The certifier signs at 13d and enters the date signed at 13e.
Identify the attendant
Item 14: the attendant's name and title, or check SAME AS CERTIFIER ABOVE. Items 15a and 15b: the attendant's Missouri license number and NPI number.
Complete the Affirmation of Birth block
Where this block applies, each person prints a name, signs the declaration and gives an address, and the signatures are made before a notary public who completes the seal and commission lines.
Answer the confidential items 17 to 39
Item 17: permission to give the Social Security Administration birth information. Items 18a to 20: marital status and Social Security numbers. Items 21 to 26: education, Hispanic origin and race for each parent. Items 27 to 39: transfer, prenatal care, height and weights, payment source, WIC, food stamps, previous births and pregnancy outcomes, smoking, last menses and medical record number.
Complete the medical and health items
Items 40 to 47: check all that apply for risk factors, obstetric procedures, onset of labor, labor and delivery characteristics, method of delivery, infections, tests during pregnancy and maternal morbidity. Check the None or Unknown option where the form offers it.
Complete the newborn information
Items 48 to 61: newborn medical record number, birthweight, gestation in completed weeks, Apgar scores, plurality, transfer, abnormal conditions, congenital anomalies, living status, breastfeeding, eye prophylaxis, hepatitis B vaccination and whether adoption is pending.
Review, download and print the PDF
Check that every item is complete, the signatures are in place and the Vital Records Use Only area is untouched. Download or print the completed PDF from FillingPDF and follow the agency's channels for filing.
How to submit VS 100C
The form prints no mailing address, portal or appointment rule, so it names no channel of its own. Item 16, the registrar's signature and date filed, sits under "Vital Records Use Only" and is completed by the agency, not by you.
For how to file a completed certificate, contact the Missouri Department of Health and Senior Services, Bureau of Vital Records, whose vital records registration page is at https://health.mo.gov/vital-records-registries/vital-records/register-vital-record. The official PDF is at https://health.mo.gov/sites/health/files/media/pdf/2026/04/certificate-of-live-birth.pdf.
FillingPDF lets you fill out and download the PDF; submission follows the agency's channels.
Common mistakes to avoid
- Writing in the "Vital Records Use Only" area; item 16, the registrar's signature and date filed, and the State File Number are for the agency.
- Leaving the certifier's statement at item 13d unsigned or the date signed at 13e blank.
- Signing the Affirmation of Birth without a notary: the block has a section for "Subscribed, declared and affirmed before me" with the notary's seal and commission expiration.
- Mixing up the mother's/co-parent's name prior to first marriage (9a) with the current legal name (9c).
- Checking more than one box on item 22 or 25 (Hispanic origin), which say to check only one box; race items 23 and 26 allow all that apply.
- Leaving item 28c blank when there were no prenatal visits; the form says to enter "0".
- Entering both cigarettes and packs for the same period in item 37; the form asks for either the number of cigarettes or the number of packs, and "0" if none.
- Giving birthweight in item 49 without specifying the unit; the form prefers grams and asks you to specify the unit.
Frequently asked questions
What is the Missouri certificate of live birth?
It is Form VS 100C (MO 580-0697), issued by the Missouri Department of Health and Senior Services. The form records a child's birth, the parents, the certifier and the attendant, plus confidential medical and health information, and carries a State File Number and a registrar's date filed.
Can I fill out the certificate of live birth online?
Yes. You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service and does not file the form with the Department; filing follows the agency's own channels.
Who signs the certificate of live birth?
The certifier signs at item 13d, certifying that the child was born alive at the place and time on the date stated, and enters the date at 13e. The form also has an Affirmation of Birth block signed under penalty of perjury before a notary public.
What does "Confidential information for internal use only" mean on this form?
The form prints that label over items 17 to 39 and over the medical and health and newborn sections (items 40 to 61). It covers entries such as marital status, Social Security numbers, education, ethnicity, race, prenatal care and smoking history.
What is the Vital Records Use Only section?
It is the area at item 16 where the registrar signs and enters the date filed. You do not complete it. The State File Number at the top of the form is also assigned by the agency.
Where do I submit the certificate of live birth?
The form prints no address or submission channel. Contact the Missouri Department of Health and Senior Services, Bureau of Vital Records, using its vital records registration page at health.mo.gov for how a completed certificate is filed.
Is this the form for a delayed birth certificate?
No. The Bureau of Vital Records describes a separate delayed registration process for a person who is 12 or older, was born in Missouri and has no registered birth certificate. It uses its own affidavits and two supporting documents.
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