What must occur for a physician to be considered in attendance?

For a physician to be regarded as in attendance at the time of birth, it is necessary that they actually witness the birth. This requirement ensures that the physician has firsthand knowledge of the event, which is crucial for legal, medical, and ethical reasons. Being present during the birth allows the physician to verify the circumstances surrounding the delivery, contribute to immediate care if needed, and accurately document the incident, including vital statistics for the birth certificate.

The other options involve actions that do not directly confirm the physician's presence at the actual birth event. For instance, being the primary caregiver at birth or present during prenatal check-ups pertains to ongoing medical care rather than immediate oversight of the birth itself. Similarly, while signing the birth certificate is an important step in the legal documentation process, it does not fulfill the requirement of being physically present during the birth. Thus, witnessing the birth is the definitive criterion for a physician to be considered in attendance.