Prenatal Record - National Archives and Records Administration

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coL,...aoo•? •••• INFECTIOUS DISEASE AND SYSTEM REVIEW INTERVIEWER'S SECTION 7. DIGESTIVE SYST!MJ Ever b.., put on o .,eciol diet 0? 0 Ulcer Ever hod ulcers 0 ? Stamoch troulllo 0 ? J-dlco 0 ? Ever had any trouble with your bo-Is? 0 ? PATIENT'S COMMENTS: 0 Chronic Diorrhoo 0 Ulceroth•o Colitis 0 Cholecystitis 0 Cholelithiasis OOther PHYSICIAN'S SECTION 8. GEMITO.URINARYt Ever had any troulllo with your 0 Syphilis bladder 0 ? Buming 0 ? Hurt to empty 0 ? Kidney 0 N!isaerian trouble O ? Infections 0 ? Blood In owlno 0 ? GraYOI 0 N.,hritls or stanos in uri no 0 ? Evor any infocti.. of your tubes 0 Nephrotic S,ndromo or ovarioo 0 ? Inflammation of g.,it..s 0 ? 0 Hydronophouia PATIENT'S COMMENTS: 0 Nephrolithiasis 0 Recurr.,t Pyolonophrltls 0 Recurr.,t Cystitis 0 Chronic S.lpingo-Oophoritis 0 Other I 9. CIRCULATORY SYSTEMI Ever hove any troulllo with 0 C.,.oatlvo H-rt Failure your heart O ? Ever ha¥0 trouble gottt,. ,.ur llreoth whon 0 Rheum•ic Heart Disoose your heart boats fost 0 ? Any trouble with hlth bloo.t 0 Myocer
C:OLft-IOOa-7 1··· INFECTIOUS DISEASE AND SYSTEM REVIEW INTERVIEWER'S SECTION 12, RADIATION: Ever had radium tr-montQ? X·Ray treehllantQ? Radto-iaot--0?·-- -- --- -- PATIENT'S COMMENTS: 13. ENDOCRINE: Ever had thyroid trouble 0? Evot had a thyroid toot 0? Ever talcan thyroid 0? Ever had diaboteo 0? Ever telcon harman .. 0? PATIENT'S COMMENTS: 0 Radium Therapy 0 x--Ray Therapy ·-- · · ··· 0 Radioactive loatope Treat-nt 0 Hypothyroidiom 0 Hyper:thyroid iom 0 Thyroiditlo 0 Diabetoo Mollituo QOther PHYSICIAN'S SECTION I 14. BONES, JOINTS, MUSCLES: Ever had ooro or owallon jainto 0? Rh.......,tiom 0? PATIENT'S COMMENTS: O Arthritio QJoint Oiooaso QRickoto QOther I 15. NEUROLOGICAL: Ever fainted or last consciousness 0? Ever had canvuloians 0? Fits or opes111s 0? Epilepsy 0? Paralysis 0? Da you have corobral palsy Q? Any trouble -i119 or h-int O? PATIENT'S COMMENTS: 0 Cerebral Paloy 0 Convulsive Disorder QBIIndnou QDeafneso QOther 1 16. BIRTH AND INFANCY: Old you have any difficulty In tho first faw 111antho of lifo 0? Convulsions 0? Jaundica 0? How -ch did you woith?___Was there anythint unusual about your 111ather's pro1nancy ouch as convulolans 0? BIHdint Q? Was there anythint in y- bady that wasn't fa,.., ritht whan you w.,. born 0? PATIENT'S COMMENTS: 0 Etythroblastoslo 0 Pro111atutity 0 Birth Injury 0 Other condition nat llotod CONGENITAL MALFORMATIONS 0 Cardiac Malfor111ationo 0 Coarctation of A- D Cleft Palate QHoro Lip 0 Othor Co"l-ltel Malfor111atians I j 17. ACCIDENTS, POISONS, AND VIOLENCE: Ever bHn in ony bad accidants 0? Ever taken any peisons 0? PATIENT'S COMMENTS: 0 Liu and describe Coll....,atlvo Reoeorch Porlnetel Raoeorch Bronch, HIHDB, NIH Bethesda 14, Md. I (oa.n PAGE 30F 3 II.A.ll9 OB-7 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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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
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DEFINITION OF CODES (Continued) FIE
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'? 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
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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 and 136: OB-7 Infectious Disease and System
Page 139: COLIII.•I00 ..7 ,... INFECTIOUS D
Page 143 and 144: DEFINITION OF CODES nlFECTIOO'S DIS
Page 145 and 146: DEl''ll'IITION OF C:JDES ( Conti:::
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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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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
Page 187 and 188: DEFINITION OF CODES (Continued) FOF
Page 189 and 190: 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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!:: 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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