Minnesota Registration & Certification System (MR&C)
Facility Authorization & Agreement
Facility* Name ________________________________________________________________________
Address _____________________________________________________________________________
My signature below indicates my understanding and agreement with the following terms and conditions:
The Facility will maintain a computer and appropriate Internet connection for the MR&C
System.
The Facility will oversee and make every effort to ensure every birth and fetal death occurring at
this facility will be recorded and finalized within five days of the birth as required by Minnesota
Statute 144.215.
The Facility will provide unmarried parents with written materials, forms and information orally
or through video/audio about the Voluntary Recognition of Parentage program and the rights,
responsibilities, alternatives and legal consequences of paternity establishment.
The Facility will give unmarried parents an opportunity and provide a notary public for signing
Voluntary Recognition of Parentage forms.
The Facility will fax signed original Voluntary Recognition of Parentage forms to the Office of the
State Registrar as the forms are completed.
The Facility will manage and maintain its personnel’s access to the MR&C System and remove
(or request MDH to remove) users promptly at the time of termination or change in roles.
Failure to comply with any terms or conditions listed herein may result in sanctions for the Facility
and/or suspension of system privileges.
I have the authority to sign on behalf of the Facility and I authorize the staff listed herein to have access
to the MR&C System:
Name _______________________________________________________________________________
Position at Facility _____________________________________________________________________
Email ____________________________________________________
Phone ___________________
Signature _________________________________________________
Date ____________________
*“Facility” includes hospitals, birthing centers and midwives registering births through MR&C.
Facility Authorization: fax to MDH (651-201-5750) upon implementation and any administrative changes.
Individual User Agreements: Facility to maintain and retain original signatures and fax copy to MDH.
revised 8/12/2015
Minnesota Registration & Certification System (MR&C)
Birth Registrar Individual User Agreement & User ID Application
By signing this application I acknowledge that I have read the Facility Authorization and I will assist the
Facility in compliance with the terms and conditions as listed. Additionally, I agree that:
I will not compromise the security of MR&C by sharing my password or logging into MR&C with
any user ID other than my own. I agree to log out of MR&C any time I am not using it.
I will only access MR&C from Facility-authorized computers while working in my capacity as a
birth registrar.
I will not print or distribute any reports for use by anyone other than Facility personnel with a
demonstrated need to know.
I understand that by use of MR&C, I may have access to the records entered by the Facility after
they have been replaced due to adoption or other confidential court actions. I will not disclose
these findings or any data from the previous record in any manner (oral, written or otherwise)
to anyone including the subjects of either record for any purpose.
I understand that if I violate any of these agreements, my access to MR&C may be terminated
without notice.
I understand penalties for unlawful use of data exist under Minnesota Statutes 609.87-609.98
and Chapter 13 and any person violating these sections of the law may be subject to penalties
up to and including fines and imprisonment.
Name _______________________________________________________________________________
Signature ____________________________________________________________________________
Email ____________________________________________________
Phone ___________________
Authorized by (signature) _______________________________________________________________
Position of authorizing person ___________________________________________________________
Facility Name _____________________________________________
Date ____________________
Facility Authorization: fax to MDH (651-201-5750) upon implementation and any administrative changes.
Individual User Agreements: Facility to maintain and retain original signatures and fax copy to MDH.
revised 8/12/2015