Prenatal Record - National Archives and Records Administration

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.. • PAST MEDICAL HISTORY (Interviewer) ~. TNNIII"UIIONI ZL DATil & NllAION JO. NllACTION lifo. Yr. QNONII 0 m QNONK 0' CJNONE 121 0 Ill QNONII 0 II. •LOOD TUTI TAICIEN l2. DATE ILNilAION 34. IIIESULT lifo. Yr. g_NONE Ill (ZI (JI (41 (II
Reproduced at the <strong>National</strong> <strong>Archives</strong> H H • • > \0 ...... @ I 0'1 ~orm Ite~ Numb~rs ltn~Pd to nata Items on nB-&, Past uejtcal H1storv ITEU I'IATA nN TTF:M CARll FORM rn ~liM FROM tn DATA TTF.:I4 ~ANF. 4 uq•• •na-6 1306 17 18 Form 4 411 ••• 08•6 2306 17 18 Form nB-b datP (dayl 08•6 d~t~ (jay) 4 3811 •••1J8•6 1306 1S 16 Form ns-6 dAte ('110) 4 410 ••• 08•6 2306 1'5 16 Form 08•6 dAtP ('110) 4 390 ••• 08•6 1306 tQ ?.0 Form na-6 datP Cvr> 4 412 ••• n8-& 2306 19 20 Form na-& date (yr) r; 391 ••• ns-6 1306 21 ?I Hnsnitalizatlon, nu~ber '5 570Q •••• VAR 318 318 Hosnltalizations 12 months or 'IIOrP prior to study, total nulllber 6 40'5 ••• 08•6 1306 411 49 Hosoltallr.attnn, nth, d8te (mo) 6 Hfi ••• 08•6 1306 30 H HosoH all zat lon, nth, date (:n('l) 6 4o2 ••• n8-& 1306 42 43 Hosoitaltzation, nth, cil'ltP (110) 6 3 93 ••• n8-6 1306 24 ?5 Hosottaltzatlon, nth, 6 397 ••• na-6 1306 32 33 H~soltattzatlon, nth, date dl1te (Tin) Cvr> 6 406 ••• 08•6 1306 50 51 Hospltaltzatlon, 6 403 ••• 08•6 tJo~; 44 45 Hospitalization, nth, nth, d&te cl8tP. (yr) 6 400 •• • 08•6 1306 3R 19 6 394 ••• os-6 1306 26 ?7 Hosottalizatlon, Hosottatlzation, nth, nth, date d8te Cvr> 6 39Q ••• 08•& t 306 36 17 Hosottaltzation, nth, date, (mol 8 404 ••• 08•6 1306 46 47 Hosoltalization, nth, illness or ~isabilitv 8 401 ••• 08-6 1301; 40 41 Hospitalization, nth, illness or disabllltv 8 392 ••• o8-& 1306 22 23 Hosoitaltzatlon, nth, iJlne5s or dlsabllity 8 398 ••• 08-6 1306 34 35 Hosoitalization, nth, illness or disability R 39'5 ••• 1JB•6 13011; 2R 1.9 HCisoltallzatton, nth, illness or ~lsabllity q 413 ••• 08•6 2306 21 71 Radtolooicat PXa'IIS or tre8tments, nnmher, orecedlnQ 12 months to 421 ••• 08•6 2306 H 34 R~tdtolo'llcal Pxa•s or treatments, nth, riate, prececllno t2 months (mo) 10 41A ••• 08-6 2306 211 ?9 Radfoloolcal ex8ms or treatments, nth, date, orecedlna 12 months (1110) 10 4t"i ••• o8-6 2306 2l 74 R~tctfoloatcal exams or tre~tments, nth, date, orecect!nQ 12 months (1110) tO 424 ••• 08•6 2306 ]R 39 Radlolo~lcal ex&IIIS or treatments, nth, date, precedlna 12 months Cmo) to 422 ••• 08•6 2306 35 36 Radloloatcal exams or treatments, nth, riate, precedlnq 12 months cvr> 1 0 416 ••• os-& 2106 25 76 Radtoloolcal ex ... ~s or treatments, nth, dlllte, orecedinq t2 months cvr> to 425 ••• 08•6 2306 40 41 Radfoloatcal exams or treatments, nth, date, precedtna 12 months (yr) 10 4t
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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 79 and 80: Reproduced at the National Archives
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 117: 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
Page 163 and 164: DEFINITION OF CODES (Continued) FIE
Page 165 and 166: ~ :: : j: ~ : I~ =r ; Ia ~ ~ !~ ;
Page 167 and 168: ,;.-~ 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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