Prenatal Record - National Archives and Records Administration

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II.A.ll4 OB-7 Reproduced at the National Archives
Reproduced at the National Archives H H • >. ...... ...... l11 B ~ 4RO ••• DR•7 4Rt ••• OR•7 4R2 ••• 0R•7 48l ••• uR-7 tfl4 ••• ol'l-7 49s ••• oR-7 Oata Ite'lls RPff!rencinc, For"' nB-7, Tnff!cttous Disease a~1 System Peview OAT I\ TTF.114 ITE"' JJI CI\Ril TO F'JRM NIIM FROM rn OArA lTF.N NAMF 444 ••••••• 0307 t 5 CIHi number (sequf!ncf!, for11 tvpP, for'll number, revision· nullbf!r) 445 ••••••• 0307 6 14 NTNOB C~SP numbf!r 446 ••• oR-7 0307 1"i t6 Form na-7 d~tP (!110) 447 ••• 01'1-7 0307 17 t8 ~nr111 nR-7 d~te (:t8y) 448 ••• oR-7 0307 19 ?o ~or"' ns-7 d~te (yr) t49 ••• oR-7 1 0107 2t 21 C~ll:t~oo:t dlsP.ases: of!rtussls 450 ••• 0R•7 l 0307 2' 23 C~il:thoo:t diseases; oertussts, 8:1@ onsf!t 4~t ••• oR-7 1 0107 24 ?4 C~il~hoo:t dtsf!ases: chicke"' oox 4o;2 ••• oR-1 1 0307 25 ?6 C~1l:thoo:t diseases: chiCkPn POX, ac,e onset to;l ••• oR-7 1 0307 27 11 C~ildhood diseases: 'IIUIIIPS 4"'i4 ••• oR-7 1 0307 2A ?9 C~il:t~oo:t diseases: 11UIIIOS, a:te onset 4'55 ••• 01'1-7 1 0307 30 30 Child~oo:t disPases; rubf'll:t: Ger11an rnPaSlf!S 4'56 ••• oR-7 l 0307 lt 32 Chil:thoo:t dtsPa~e$; 4'57 ••• oR-7 1 0307 33 33 C~ildhoo:t diseases: 'llt"aSlf!S rubell!; GPr11an measlP.s, aqe onset 4'58 ••• 01'1-7 1 0307 34 35 Childhood diseases: 11eastes, aqe onset 459 ••• oR-7 1 0307 36 36 C~il:t~oo:t diseases: diohtherh 460 ••• 0R-7 1 .0307 ]7 J8 Chlld~oo:t diseases: :tto~t~eril'l, aqf! onsf!t tfit ••• oR-7 1 0307 H 19 C~il:t~on:t dtsPases; scarlet fPYf!f 4fi2 ••• oR-7 t 0307 40 41 Chlld~ood diseases; scarlet fPYf!r, AQe onset 4fi3 ••• oR-7 2 0307 4? 42 Infectious ~tseasesr oolio11Vel1 tis 464 ••• 01'1-7 2 0307 41 44 I~fPctious diseasPs: ootio11velitis, aQf! onset 4fi5 ••• oR-7 2 0307 4"i 45 Infectious diseases: herof!s stmolex 466 ••• 01'1-7 2 0307 46 47 Infectious ~iseases: 4~7 ••• 01'1-7 2 0307 411 48 InfPcttnu~ rtiseasPS1 heroPs sl'llolex, 8qe onset neroPs zoster 46B ••• OR•7 2 0107 4Q so Jnt~ctlous ~iseases: neroes zoster, aqe onset 4fi9 ••• 0R•7 2 0307 51 'H Infectious ~lse~s.-s: encer~halltfs 470 ••• 01'-7 2 0307 5? S3 Infectious ~lse~tses: enceohAlftfs, "Cie onset 47t ••• oR-7 2 0307 54 ~4 Inff!ctlous 1iseasPs: 111enin~lt ts 472 ••• 0~-7 2 0307 5~ '56 Infectious ~~~eases: 'llentn:::Jttts, aqe onset 473 ••• DR•7 2 0)07 57 ~7 Infectiou~ ~iseases: toxoPlAsmosis 474 ••• oR-7 2 0307 59 S9 Infectiou~ rti~easPs: tO'IrODlltSIIIO~iS, aqe onset 475 ••• 0"'•7 2 0307 60 60 Infectious ~ise~ses, tst other, tvoe 476 ••• oa-7 2 0107 61 ~2 Infectious ~iseases, 1st other, !IQe onset 477 ••• 01"-7 2 0307 6] 63 IntPctlous ~iseasf!s, 2no1 ot~er, typ@ 478 ••• DR-7 2 0307 64 65 Infectious ~lseases, 2no1 ot~er, aqe onset 479 ••• 01'1-7 2 0107 66 66 InfPctiou~ ~ise"ses, Jrd other, tvoe 2 3 3 3 3 3 0107 OJ07 0307 0307 0307 0307 67 69 70 7'2 n 75 68 69 71 72 74 75 Infectious Infectious Infectious Infectinus Infectious IntPctious diseases, diseases: ~iseAses: diseases: rtiseases: 111seases: 3rd other, aqe oarasitic 1st, oarasttic tst, parasitic ?.nrt, paraslt.ic 2nd, oarasttic 3ro1, onset tYPP ac:te onset type arJe onset tvoe
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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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DEFINITION OF CODES (Continued) FOR
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DEFJNITION OF CODES (Continued) FOR
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"' 1: : ~~ :; "':J. !~ ~ ~ :~ ~ ; :
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HISTORY SINCE LAST 1-ENSTRUAL PERIO
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HISTORY SINCE ~T MENSTRQ~ P~RIOD {C
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OB-4 Gynecological History Form OB-
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COL.,.-aaaa-4 RIEV. tt-11 • GYNEC
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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 93 and 94: Reproduced at the National Archives
Page 99 and 100: DEFINITION OF CODES RECENT MEDICAL
Page 101 and 102: DEl!'INITION OF CODES (Continued) F
Page 103 and 104: DEFINITION OF CODES (Continued) FOR
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 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: 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'
Page 169 and 170: OB-9 Prenatal Record Form OB-9, Pre
Page 177 and 178: C:OL.II.·- I•It NU\E IHOSPITAL
Page 179 and 180: •• 'HISTORY NO. diRIRXL IXXMI l
Page 185 and 186: ~~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 ( 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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