Data used to categorize individuals for identification, records matching, and other purposes.

Data Element

Multiple Birth Order

If not a single birth then the order born in the delivery, live born or fetal death (1st, 2nd, 3rd, 4th, 5th, 6th, 7th, etc.).


CDC's Consolidated Comment for USCDI v5

  • Proposed change: Please promote Plurality data element to the same schedule as Multiple Birth Order. Plurality compliments Multiple Birth Order by being the number of fetuses delivered live or dead at any time in the pregnancy regardless of gestational age, or if the fetuses were delivered at different dates in the pregnancy. For birth and fetal death reporting Multiple Birth Order can only be activated when Plurality is 2 or greater.
  • Please clarify that this is only applicable if Plurality is 2 or greater and is not very meaningful without the total at delivery (e.g., 2nd of 4 total).
  • Justification: Through active collaboration with State Vital Records Offices and electronic birth registration system vendors the Vital Records community has been testing within EHR sandbox environments and conducting birth reporting data quality projects accessing these data in hospital environments. Specific to these active projects in FHIR, Epic hospitals are getting Multiple Birth Order information fairly regularly.

NACCHO supports CDC's recommended change.

CDC's Consolidated Comment

Data elements of interest:

  • Multiple Birth Order
  • Patient Birthplace

Birth Reporting use case:

The Division of Vital Statistics (DVS) within CDC’s National Center for Health Statistics (NCHS) continues to supports inclusion of Multiple Birth Order and Patient Birthplace into USCDI.   These elements are part of the items collected within the provider supplied worksheets that hospitals complete. These data elements track demographic and health trends that includes pregnancy risk factors and preterm births. The inclusion of these elements in USCDI would have a significant impact on natality reporting by reducing the burden of duplicative data entry and streamlining the process flow.  The primary objective is to improve the timeliness, quality, and sustainability of vital statistics reporting.  The inclusion of these elements would not only support national level reporting but also benefit State partners who are the first line of receiving these data and clinical providers who are on the first line of sending these data. Inclusion of these elements would support interoperability among the vital statistics ecosystem.  DVS and State partners have been focusing working towards using the HL7 FHIR standards that adhere to the US Core resources within their implementation guides when possible.





Link to use case:

  • Guide to Completing the Facility Worksheets for the Certificate of Live Birth and Report of Fetal Death (

Additional technical specifications:

  • Provider worksheet for multiple births:
  • Provider worksheet for live birth:

Applicable standards list:

  • HL7 FHIR Vital Records Birth and Fetal Death Reporting: HL7.FHIR.US.BFDR\Home Page - FHIR v4.0.1




Unified Comment from CDC

CDC considers this element to be high priority and strongly recommends its inclusion in the USCDI V3.

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