:出生证明格式（中英文）

　　mother (included this one) :

　　Duration of Pregnancy (No. of weeks) :

　　Weight at birth :

　　Single or multiple births :

　　Date of Birth :

　　Address & Place of Birth :

　　Delivered by : Hospital / Clinic / Midwifery / Home

　　others

　　Physician / Midwife / others

　　Special symptom of birthgiving mother & infant before & after childbirth seen in medical diagnose