Prenatal Record - National Archives and Records Administration

Reproduced at the National Archives
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nata Ite111s Rl'fPrl'ncln:J Fnrm
na-&, Past Ml':ltcAl Hfstorv
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TO FJQ~ NIIM FROio! rn DAfA TrF.M NAMF:
3A6••••••• 1106 t 5 Cartt numbl'r (SeCJUl'nCe, for11 tVpf', form nu'lloer, revision number>
387 ••••••• 1306 6 14 NTNOB C~Sl' number
3AB ••• OA•6 4 1306 1'5 t6 Fnr"' ne-& d~t"" (110)
3R9 ••• 0R•6 4 1306 17 18 Form OB•b d~tP C:Javl
3CJO ••• OR•6 4 1306 1Q 20 ror'll nB-6 dati" (yr)
3Q1 ••• 0R•6 5 1106 21 2t Hosoltallzat ion, number
3IJ2ooo0R•'i II 1306 22 73 Hosoital17.at1on, nth, t llness or dlsabilltv
3Q3 ••• oR-6 6 1306 24 25 Hoso1ta11zat1on, nth, d!ttl' ('110)
3CJ4 ••• 0R•6 6 1306 21' 27 Hosoltallzatton, nth, d~te Cvr>
3QS ••• OR•6 8 1306 2R 29 Hnsoltallzattnn, nth, lllness or 1tsab1Jttv
3CJ6 ••• oR-'i 6 1106 ]I) 31 Hosoltallzation, nth, 1/ttl' {110)
3CJ7 ••• oR-'i 6 l306 3? 13 Hosoltalization, nth, rlatl" Cvr>
3CJ8 ••• 0R•6 8
1306 34 JS Hosnitall7atton,
JQ9 ••• oJ:~-6 6
1306 ]I\ 37 Hoso1ta11zat1on, nth, illness or disability
nth, d!ttP, (litO)
4no ••• oR-6 6 1306 38 19 Hosoltalization, nth, dati" Cyr)
40t ••• oR-6 8
1306 40 41
cn2 ••• oR-6 6
1306 4? 43 Hosoitallzatton,
Hosoltaltzation, nth, lllnpss or rHsah111tv
nth, dati" (110)
401 ••• 01\•6 6
1106 44 45 Hosoitalizatton, nth,
\0
404 ••• oR-6 8
lJOf' 41' 47 Hosoitaltzatton, nth,
w cos ••• oR-6 6 1306 4A 49 Hnsnitalization, nth, datP {110)
406ooo0R•6 6 1306 so 'H Hosoitali7.ation, nth, datP rvr>
407 ••••••• llOf' 52 AO Blank:
408 ••••••• 2306 t 5 c... r1 nurnbl"r CseCJuence, for11 tv~e, fOr'll nU'IIbl'r, revision number)
409 ••••••• 2306 6 14 NTNOH CASP nombf'r
tto ••• oR-6 4 2106 1'; 16 Fnrrn OR•b date ('110)
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"'
dAti" (yr)
lllnl'SS or rltsabllltv
411 ••• oR-6 4
2306 t7 18
412 ••• 0R•6 4
2106 19 20 Form
Form nB-6
ns-& rl~tl"
dati" ("'ay)
rvr>
413ooo0R•6 9
2306 21 21
414 ••• oR-6 12-13 2306 22 22 H,.dfolo!lical Pxa:ns or
Rit:Holoair-al PX't'IIS or treatments, number, orecedlnq 12 months
treAtment!':, nth, tvoe, oreced1n~ 12 ~onths
4ts ••• oR-6 10 2306 23 24 Rildfoloatcal f'XA'RS or treAtml'nts, nth, rtate, nreceding 12 months
(mn)
416 ••• oR-6 10 H06 25 26 Radtoloaical Pxarns or treatments, nth, date, Preceding 12 months
(yr)
417 ••• oR-6
41B ••• DR-6
419 ••• DR•6
420 ••• 0R•6
4?1 ••• 01'1•6
12-!3
10
10
1'-•13
10
2306
2301'
2306
2306
2306
27
2A
30
32
H
27
29
4?2 ••• 0R•6 10 2306 35 36
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Radfo\oQic:al
R1'111oloairal
Cmo)
Radioloaical
cvn
32
34 R,.dloloaical Radfoloaical
Pxarns
PX811S
I"XAms
ex a ;as
ex~t'IIS
or
or
or
treatments,
tre1'1t'llents,
treatments,
or
or tre8tments,
treatments,
nth,
nth,
nth,
tvol',
rtat.e,
rtate,
orecedinq
nrecl'dlna
orl'ced1nq
12
12
12
months
months
months
nt.ll,
nth, tvoe,
rtate, precl'd1ng
orecedlna 12
t2 ~onths
months
(mo)
RAdfoloQical exa11s or treatments, nth, date, Prl'cedlnCI 12 months
Cvr)