Examples
| Birth Weight (grams) | Gestational Age (Weeks/Days) | Transferred In | Event | CPQCC DB Eligibility | Forms Needed |
| 350 | 22/0 | No | None | Eligible | Admission/Discharge |
| 400 | 21/6 | No | None | Not Eligible | - |
| 401 | 21/6 | No | None | Eligible | Admission/Discharge |
| 475 | 23/6 | No | Delivery Room Death | Eligible | Delivery Room Death |
| 475 | 23/6 | Yes - Chronic Care | None | Eligible | Admission/Discharge |
| 475 | 23/6 | Yes - Surgery | None | Eligible | Transport-In & Admission/Discharge |
| 1500 | 30/0 | No | None | Eligible | Admission/Discharge |
| 1500 | 30/0 | Yes - Growth | None | Eligible | Admission/Discharge |
| 1501 | 22/0 | No | None | Eligible | Admission/Discharge |
| 1501 | 22/0 | No | Infant Death | Eligible | Admission/Discharge |
| 1600 | 20/0 | No | None | Not Eligible | - |
| 1600 | 20/0 | Yes - Chronic Care | None | Not Eligible | - |
| 1600 | 20/0 | Yes - DX/RX Services | Acute Transport-In | Eligible | Transport-In & Admission/Discharge |
| 1600 | 30/0 | No | Ventilation > 4 hours | Eligible | Admission/Discharge |
| 1767 | 31/1 | No | Delivery Room Death | Eligible | Delivery Room Death |
| 1890 | 32/5 | Yes - Insurance | None | Eligible prior to 2019. Not Eligible starting from 2019. | Prior to 2019: Transport-In & Admission/Discharge/ 2019 or later: No form needed |
| 1600 | 30/0 | Yes - Growth | None | Not Eligible prior to 2013 Eligible in 2013 or later | Prior to 2013: - / 2013 or later: Admission/Discharge |
| 1890 | 32/5 | Yes - Bed Availability | None | Eligible prior to 2019. Not Eligible starting from 2019. | Prior to 2019: Transport-In (only if similar or higher level of care) & Admission/Discharge/ 2019 or later: No form needed |