Prenatal Record - National Archives and Records Administration

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Reproduced at the National Archives F'orrn Ite'TI '-'u'lloers ttnk:Pd to nata Items on OI:I•H, Pene"'t Pren'ltal Hlstnrv ITE"' OATA ON TTF'Ii! CARO rnttll! JO NIJ~ FPOII! Tl'l DATA TrF:114 NUF' 4986 •••• VAR 54 54 S'llokln~ n1storv: ctqarettl."s uPr jay flOW, co:Jer1: S'IIOICer, non-smoker 4 491 ••• 08•8 030R 11 18 F'or'll OB•R dAte (:Jayl 4 490 ••• 08•8 0308 1" 16 Form n~-8 dAti." (110) 4 49? ••• oa-8 o3oA 19 10 F'nrm 116•8 dAtP ( yr) 4 4994 •••• VlR 7'5 80 Perfn=tt"l follow uo vtsft, OB•8, rtate of first C111n/,av/vr> 4 4987 •••• VlR 55 "ib Pre-natal vt!lllts, total nu'lloPr , 6 493 ••• na-8 o3oA 21 11 S1clr fn any WAY 7 494 •••08•8 030~ 2?. ?2 Heoadacht' 8 495 ••• 08·8 o3o8 23 ?3 VIsual disturbance c, 49~ •••oa-a 030" 24 24 llf"atrn~ss: n11111hness; :lfz:~:ln_!!ss to 497 ••• 08•8 030~ 2"i ?5 Vtutft t na to 5t9CJ •••• VAR 307 307 Vn~lttna hy trimester of report tl HA ••• oa-8 o3oA 21> ?b Pl91n, ab::I.,IIIPO, nelvfs, bar< 12 499 ••• 08•8 0308 27 ?7 Urtnarv urqPnry: 1ysurl'l H t] o;oo ••• os-a 01011 2fl 28 DfarrheA H 14 so1 ••• ns-a o3oA 29 29 • • > 15 '50? ••• 08•8 03011 30 30 ..... 15 519R •••• VAR 301> 306 w 16 !i01••• ns-8 0108 31 31 0'1 @ I (X) Colrt: snre throatr Ff'Yf'r Fevf'r by trimester Eve inflan~•atton cougt-t of rf'oort 17 '504 ••• na-8 0308 32 n Rash; skin contfftfon 18 50'5 ••• 08•8 03011 33 H Jlllun:ltcf' 18 5?00 •••• VAR 3011 308 Jaundtcf' hy trimester of reoort 19 '506 ••• 08•8 OlOA 34 34 swollPn atand~ ?.0 '50'7 ••• ns-8 030A J" 15 Cnld ~ores ?1 o;oR ••• ns-8 03011 Jf; 3b Bolls: ab!IICPssed teeth 22 o;oq ••• os-8 O'OII 37 17 F.arache 23 5tn ••• ns-8 030A 311 18 sweJltna nt tPet or lPQS 24 5201 •••• VAR 309 ]09 E~ema nan~s or face by trtrnPster of rPport 24 511 ••• 08•8 OlOA 39 19 swelltna of nan1s or f
Reproduced at the National Archives For~ Ite~ ~u~b~rs link~d to nata Items on ns-8, Re~e~t Pren~t~l Hlst~rv ITE" nATA ON TTF.14 CARl" FORIIII II) NIIM f"RQIII TO OIITA TJF:I4 NAME 3& ";2l ••• IJR•8 OlOA 51 '52 Int~rcourse tre~u~ncv 37 41Jti'5 •••• VlR 5? '53 smolclnQ history: Cl!larettP.s PPr ::lilY now, null'ber 17 '52'5 ••• 08•11 03011 61 f\4 Smolcincn cil'larettl"s, numoer PPr ::IllY 39 ";26 ••• 08•8 030R f.l'5 65 MP.dtc~tton taken H 527 ••• ns-ll o~o" 6'> f\6 Physlcilln vfsft~~ 1-t 1-t .> ..... w ....... ~ 00
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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 ,.
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GY1~F..COLOGICAL HISTORY (Con't.) O
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08-5 Recent Medical History Form 08
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DEFINITION OF CODES RECENT MEDICAL
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DEl!'INITION OF CODES (Continued) F
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Page 107 and 108: ILL..'1ESS OR DISABILITY CODES (Con
Page 109 and 110: Reproduced at the National Archives
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 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: I. ftATIIMT IDfNTIPICATIOM REPEAT P
Page 161 and 162: DEFINITION OF CODES (Continued) FOR
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
Page 191 and 192: DEFTIHTION OF CODES (Continued) FQR
Page 195 and 196: ZEFT1ITTIO:i OF CODES (Con"'c:..!!U
Page 201 and 202: DEFINITION OF CODES ( Con~inued) FC
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Page 207 and 208: !:: 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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