Prenatal Record - National Archives and Records Administration

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------- Reproduced at the National Archives ·x:re~ # _.:_ 0~ fOilkto if R RIDENT MEDICAL HISTORY FORM OB-5 1. 5"' ') 8 q jill ') 6 'J '} 8 9 1 8 lj ~· ' X f--- 121. ~ 1 • ' 10 II 12-f:i"l• tilililiTt1ii \ jfjj 20S ,,,-~lO:ill21JlO$li 1Jtlt~-· ~ ''.ru••-..~,-~ ~II~ lt6i6fifif6! U61 6Ut li71if1l14JS-i6 1111,10 0 Ill J. I 1 1 1 1 ) z 4"' I H -- tARO H ()) 5 • • • > ~ ~ ClO en I--; 1- I ~- •·llllJ).B. :-: i ~ ~ !t ~~ l>RTE lllNE~S OR \)lSA81UT~ REQUlRltl6 CONFUlE~Et-tT FORM t.OMPWI r n -:m: D[. J>ATE l)RTE .DATE DRTE ONSE'T ONSET OMSEl ONSET !! • .... ~ ~ ~~ ~ ~ ~:-: ~ ~}, @ ~~ I~~:.: ~ ~ ~ ~ ~ ~ ~ "' ~ I; .. ~ ..-; "' I~ tu ~ ~ ~ • ~~~~~!~~~~!~~~~~~~~~~~! ~ .. t BlRKK I : i-, I Z J 4 ~ 6 * Item numbers 1 I 9 10 II 11 IJ 14 IS k 11 II t :Ill 22 n 4 21 I!_!! ~ ~-~ ll II 1~ IS 16 J1]' lf40 I ~; a· 4 ~~ 1641 I 4• 10 Sl Ul 4 5 56 S1 511 t 6IJ 162 J 64 refer to form dated: Rev. 11/59 ~ 6J6Ut 10 71JUJ74 7J 71 17 11 1t 10 @ I l11
Reproduced at the National Archives -- I .0 12. lt. ~12. 13 R -- ·~ ·~ --- REX:!ENT MEDICAL HISTORY FORM OB-5 rtl?M_I#: . Dll FoltM V. ' 0 0 .. /lEV. -o·' OAILJI X f---. f2T4 6Tit_lii_II_I_Hi14 ~ilili11 ltli l2tr. 11 2• 'nliv-11 29-m ii ifl1 1• u 16 li"» ~· .o iio J 44 cs"M" 47-d 49 - Si ~i sJ sc ss ~~iII s9 606162 u6tis 1 a t po i ,~; 4 -s -, 1111· "1110___ -- -· -I J)RTEI NON-CONFINltJG ILNESS Of? .biSABILIT~ MEDICATION OR IN JfCliON fORM 1 --- tGMMltj) I: li' :m:. z 1 ~TE l>llTE l>I\TE i 0 l ONSET ONSET ONSET I~ - I~ ~ " 4 I~ ... ' ~ --- CRRD ' ~IIJJ).B'~~- ~ It ~ ~ ·- ~ ~ ~ ~- ' ~ 8/.&tiiC H \0 5 , I~ t ... ... 'll~ ., 1.. q H -- 2365" ' ~ " 1:~ ~ ~ 1 .. ~~ .. ,: ~ :: li 0 s ~ ~ ~~~ I"~~~ ! " 1~1' > ~ I~ 1 'I;~ ~1.... ~ oc. ~ 1- " 0 ~~Iii I~ I~ I~ ._I~ I~ ~ ~ Ill (X) ' • I• I~ ., -~.~~ . , ~~~ I~ I• 1il~ '~"I~ lc (J ...... all? 7 llttl~l~ IG ~ ,
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NINCDS COLLABORATIVE PERINATAL PROJ
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NINCDS COLLABORATIVE PERINATAL PROJ
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INTRODUCTION DOCUMENT OBJECTIVES AN
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Forms The first forms used in the s
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Reproduced at the National Archives
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selection. A n1n was used for patie
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, researcher is more likely to look
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TABLE 3. Abbreviations for Person,
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TABLE 4. Definition of Person, Time
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TABLE 4. Definition of Person, Time
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CONTENTS AR-1/0B-1 OB-2 OB-3 OB
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AR-1 Obstetrical Administrative Rec
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DEFINITION OF CODES {Continued) FOR
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... 1;:: I ~ .J.I'40JI.!9d jl5 !
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ADMINISTRATIVE RECORD MANUAL PHS-30
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ADMI!liSTRATIVE RECORD ;fl.A.TI.TUA
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-· IID'~7-- '·"'-- ':!e- ~ l·-~
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OB-1: OBSTETRICAL· ADMINISTRATIVE
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Par. 3 10 - Religion. Record as Cat
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OB-2 Reproductive History Form OB-2
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COLIII:•IOoa-& ,.., REPRODUCTIVE
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DEFTIITTION OF CODES (Continued) FI
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1 Reproduced at the National Archiv
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R~PRODUCTI\~ HISTORY (Con't.) C3-2
Page 57 and 58: REPRODUCTIVE HISTORY (Con•t.) C3-
Page 59 and 60: OB-3 History Since Last Menstrual P
Page 61 and 62: Reproduced at the National Archives
Page 63 and 64: eoL"-aooa.a ACV. n-et • HISTORY S
Page 67 and 68: DEFINITION OF CODES (Continued) FOR
Page 69 and 70: DEFJNITION OF CODES (Continued) FOR
Page 71 and 72: "' 1: : ~~ :; "':J. !~ ~ ~ :~ ~ ; :
Page 73 and 74: HISTORY SINCE LAST 1-ENSTRUAL PERIO
Page 75 and 76: HISTORY SINCE ~T MENSTRQ~ P~RIOD {C
Page 77 and 78: OB-4 Gynecological History Form OB-
Page 81 and 82: COL.,.-aaaa-4 RIEV. tt-11 • GYNEC
Page 83 and 84: DEFINITION OF CODES GYNECOLOGICAL H
Page 85 and 86: DEFINITION OF CODES (Continued) FIE
Page 87 and 88: '? I~ 1: :1\ j; t:: t; ....J 7 ,.
Page 89 and 90: GY1~F..COLOGICAL HISTORY (Con't.) O
Page 91 and 92: 08-5 Recent Medical History Form 08
Page 99 and 100: DEFINITION OF CODES RECENT MEDICAL
Page 101 and 102: DEl!'INITION OF CODES (Continued) F
Page 107: ILL..'1ESS OR DISABILITY CODES (Con
Page 111 and 112: RECENT MEDICAL HISTORY (Con 1 t) OB
Page 113 and 114: OB-6 Past Medical History Form OB-6
Page 117 and 118: z PAST MEDICAL HISTORY (Interviewer
Page 121 and 122: DEF'll'UTION OF CODES PAST MEDICAL
Page 123 and 124: DEF'INli'ION OF CODES (Continued) F
Page 125 and 126: DEFINITION OF CODES (Continued) u.
Page 127 and 128: DEFINITION OF CODES (Continued) FOO
Page 131 and 132: PAST HEDICAL HISTORY (Con't) Item 1
Page 133 and 134: HISTORY TAKEN BY PAST MEDICAL HISTO
Page 135 and 136: OB-7 Infectious Disease and System
Page 139 and 140: COLIII.•I00 ..7 ,... INFECTIOUS D
Page 141 and 142: C:OLft-IOOa-7 1··· INFECTIOUS DI
Page 143 and 144: DEFINITION OF CODES nlFECTIOO'S DIS
Page 145 and 146: DEl''ll'IITION OF C:JDES ( Conti:::
Page 147 and 148: i i :a :: ·• 1: !: ! I! ::
Page 149 and 150: l!:i i!;T!IJIJ;: IIJ;;:..f,;:l·: .
Page 151 and 152: INF~TIOUS DIS~S~ ;~D SYSTEM REVIEW
Page 153 and 154: OB-8 Repeat Prenatal History Form O
Page 157 and 158: I. ftATIIMT IDfNTIPICATIOM REPEAT P
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DEFINITION OF CODES (Continued) FOR
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DEFINITION OF CODES (Continued) FIE
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~ :: : j: ~ : I~ =r ; Ia ~ ~ !~ ;
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,;.-~ 1•1. 1J;,.... - ~ .. u;W'o'
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OB-9 Prenatal Record Form OB-9, Pre
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C:OL.II.·- I•It NU\E IHOSPITAL
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•• 'HISTORY NO. diRIRXL IXXMI l
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~~J2ITTIGN OF CODES (Co~~i~ued) FCa
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DEFINITION OF CODES (Continued) FOF
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DEF~~ION OF CODES (Continued) PELVI
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DEFTIHTION OF CODES (Continued) FQR
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ZEFT1ITTIO:i OF CODES (Con"'c:..!!U
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DEFINITION OF CODES ( Con~inued) FC
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:t , I~ I ~ It II! I~ ::: .. ~ .. ~
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!:: llil\41.0 ~ ~~ ~'~"'~ -N OB-9 -
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PRENATAL RECORD (Con 1 t) PRESENT P
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PRENATAL RECORD (Con 't) complete a
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PRENATAL RECORD (Can't) EVALUATION
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PRENATAL RECORD (Con't) GENERAL IDl
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OB-42 Past Medical History Form OB-
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-· eoL"-aooa-..a 08-42 PAST MEDICA
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Instruction Manual for Obstetric Fo
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OB-43 Initial Prenatal Examination
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COL ..-3008-41 UIIYe 10.U) 1. PATIE
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DEFINITION OF CODES miTIAL PRENATAL
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DEFINITION OF CODES (Continued) FOB
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DEF'INITION OF CODES (Continued) FO
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I ,rnrn:r s YIN.Ct:l S6¥:;~rn I
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I, I'ATIENT IDENTI,.ICATIDN OB-43 I
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OB-10 Return Visit and Laboratory R
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DEFTIUTION OF CODES (Continued) FOR
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DEFINITION OF CODES (Continued) FOB
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4/16/61 OB-10 RETURN VISIT AND LAB
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~"........ ,... ~,_~.a., RETURN VIS
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OB-44 Prenatal Observations Form OB
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..... C:Ol..llt-IOOa-44 1. PATIENT
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:FDRMS 03-10 DEFINITION OF CODES (C
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DEFINITION OF CODES (Continued) ~·
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Instructional Manual for Obstetric
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OB-45 Laboratory Record Form OB-45
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DEFllUTION OF CODES LABJRATORY RECO
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DEFJNITION OF CODES (continued) FIE
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DEFINITION OF CODES (continued) FOR
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DEFINITIDN OF CODES (continued) FOR
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DEFTIUTION OF CODES (continued) FOR
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DEFINITION OF CODES (continued) FIE
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DEFINITION OF CODES (continuted) FI
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DEFTIHTION OF CODES (continued) FIE
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DEFTIUTION OF CODES (continued) FIE
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OB-11 Record of Current Pregnancy F
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CO~A·3C03·11 lltEV. '7·58 I. PAT
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RECORD OF CURRENT PREGNANCY (For Fo
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,... RECORD OF CURRENT PREGNANCY IN
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OB-46 Physician•s Clinic Record,
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COLR-1001-4e 4-a I. PATIENT IDENTII
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Instruction :\l:J.nual for Obstetri
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OB-12 Summary of Hospitalization fo
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SUMMARY OF HOSPITALIZATION FOR ANY
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SUMMARY OF HOSPITALIZATION FOR ANY
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':.::-•••suMMARY OF HOSPITALI
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OB-47 Summary of Antepartum Hospita
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· COLIII-IOOa..7 (CHANGIED 2-8a)
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OB-15 Drugs in Pregnancy Form OB-15
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PH S.300S.18 ..... PATIENT IDENTIFI
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.... PMS•3003•18 PATIENT IDENTI
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PHI·IOOI .. 1B P"TIENT IOENTIFIC"T
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PATI~NT IDENTIFICATION OB-15 DRUGS
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..... PHS .. 3003 ... 11 PATII!NT I
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DEFINITION OF CODES DRUGS lN PREGN
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Drugs in Pregnancy (08-15) Blank 0
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Drugs in Pregnancy (cont.} 2128 Par
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Orugs in Pregnancy (cont.) 4256 Hyo
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. Drugs in Pregnancy (cont.) 7154 S
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1 Drugs in Pregnancy (cont.) 7482 O
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Drugs in Pregnancy (cont.) 9169 917
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Drugs in Pregnancy (cont.) 9949 995
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