Prenatal Record - National Archives and Records Administration

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Reproduced at the National Archives l'a~ta Items R~fPrPnc1n~ fnrm ns-6, Past I'IP::tlcal History oara TrP:N ITE14 JN CARn TO FJPN NIIM fRO Ill TO DAr II TTEN NUF: 423 ••• o~-6 414 ••• oR-6 4?.s ••• oR-6 42& ••• oR-6 417 ••• oR-6 47& ••• oR-6 4?.9 ••• oR-6 4JO ••• OR•6 4Jt ••• OR•fi 412 ••• DA•6 4Jl ••• oR•6 414 ••• DA•6 43S ••• DR•6 416 ••• oR-6 417 ••• oR·6 438oooOR•6 439 ••• 0R•fi • 440 ••• 0R•fi 441 •••0A•6 H Ḥ )I • "' 1?.-13 10 10 16 11 lit 20 tCJ 20 Ill 20 t«< 22 24 21 24 21 24 23 2106 2)06 2)06 2306 2306 2306 2306 2306 2106 210fr 2106 2106 2106 2306 2106 2106 210fi 2106 230fi 37 ]!I 40 42 44 41\ 47 49 50 St 51 54 56 57 SA 60 61 61 64 442 ••• 0R•6 27 2306 66 66 Transfusions 441 ••••••• 2106 67 49CJl •••• VAR 1?.-13 14 !i207 •••• VAR '5208 •••• VAR 52R9 •••• VAR 27 12-13 5 316 317 Hq 31 R"::tlotoatcal I! X
z PAST MEDICAL HISTORY (Interviewer) Z. HISTORY TAKI!N BY I, 4. DATI! ..... 1 o.,•v.... I I I I I I S. UST HOSPITALIZATIONS I NOT LISTED ON 0 ..51 0NONE Ill IZI IJI 141 I. DAr~ ..... I'•• I I I I I I I I (51 I ! 7. HOSPITAL (N-• •rl A"*-••J 1. REASON t. RADIOLOGIC EXAMINATIONS OR TRIATMINTS DURING PAST 12 MONTHS (l.4ot oedt) ...JNONI! ox 10. DATI! II. 12. II. OTHER TYPE Ofl' EXAMINATION OR 14. I •••cc CHEST lifo. r- TREATMENT (OI!SCRIBI!I GIVE SITE REASON, RESULT lfl' KNOWN ~•ceMAIICT X• RAY l Ill I gNo QYIES 0 0 I QYIES I I IZI I QNO QYIES 0 0 I 9 QYIES l I QNO L;J YIES ·~· I y I 0 0 li1 I OYIES I 141 L:J YIES I QNO '-; I 0 0 ovu ' 15. OTHIR RADIOLOGIC IXAMINATIOMS OR TRIATMINTS (Prlo••• ,_, 12 _...., II, CHI!ST X.RAYS 17. OIENTAL X.RAYS: Clfl' UNUSUAL PROCIEOURIES OR NUMaiER, OIESCRIIIII TOTAL NUMaiER DURING Llfi'IE IIEXCIPT THOSI USTID AaOVLI--- TOTAL NUMIIER Ofl' IEXAMINATIOHS DURING Llfl'l IIXCIPT THOll LISTID ABOVLI--- .. EXAMINATIONS AND TRIATMIMTS OP IXTRIMITIIS (l.4ou 11. YEAR zo. TYPE OR PROCIEOURIE AND SITE Zl. REASON, fi'INDINOS lfl' KNOWN 9NONI l I :ZZ. ALL OTHIR EXAMINATIONS AND TRIATMINTS MOT IMUMIRATID AIOVI (l.loC) u. YEAR I 24. TYI'IE OR I'ROCIEDURIE AND SITE I I ~NONC COLLABORATIVC ft.S.AJICH .. ERINA TAL RCI.AftCH ... A.NCH, NINDa, NIH IREV. 11-t• (QB-6) PAOI 1 Ofl' Z BCTHESDA ,., MO. II.A.95 OB-6 Reproduced at the National Archives
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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
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REPRODUCTIVE HISTORY (Con•t.) C3-
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OB-3 History Since Last Menstrual P
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eoL"-aooa.a ACV. n-et • HISTORY S
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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 and 108: 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 115: Reproduced at the National Archives
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
Page 163 and 164: DEFINITION OF CODES (Continued) FIE
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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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DEFINITION OF CODES (Continued) FIE
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ZEFT1ITTIO:i OF CODES (Con"'c:..!!U
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DEFINITION OF CODES (Continued) FOR
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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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Prenatal Record - National Archives and Records Administration

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