2024 VLBW eNICQ Delivery Room Death Booklet, separate pages, Release 28.0 (a fillable PDF)


This booklet is designed to gather patient data that will later be entered into eNICQ. There are different booklets for VLBW and for Expanded centers. This booklet is for VLBW centers. Data Items are in the same order in the booklet as they are in eNICQ.

It should be printed on separate 8.5" x 11" pages.

Or, the booklet can be downloaded, opened in a PDF viewer, and filled out on the computer screen.

When completing the booklet on the computer screen, to navigate, either click each data item's answer with the mouse, or:

  • Use the Tab key to move from one data item to the next
  • Use the arrow keys to move from one answer to another
  • Use the space bar to select your answer

The booklet must not be submitted to VON. There is protected health information on every page of the booklet.

To download the 2024 VLBW eNICQ Patient Data Booklet, separate pages, Release 28.0 PDF, click here.