Prenatal Record - National Archives and Records Administration

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THII )14fiTO,_.Y TAKIIN • ., PRENATAL RECORD (For Plly•ici•i 4, STIRILITY WORICUP't I"R!SINT I"R!GNANCY SUIIIIMARY =NONI! CY!SIDumki 5. lot o • ., LMP (M.,.D•Yr) ul•ll•"'"' (M...o..Yr) I, F. DC: 9. TOT A'- NUW8CIIII 0_. •lllll&eNANCIII8 10. .~:·.::t~·:: II. ~~:::.T~~~ICII 12. i.':.~'; ...., ...ii'::.. 13.,:~a........;::.. 1"'.~'.......~=~... IS,=~;;:."',.';.~, •• jl6. ::;..~:.'f.!YtNe 011111 MO .. Ill) .. _..., RICORD I"RIGNAMC11S IM CMIONOLOGICAL OIDII (U•• C-i11•1i011 S"-•• iLR•••Nfi) P.REGNANCY ORDER: I 2 3 4 5 17. OAT! 01' TERMINATION OP PREGNANCY 18. GESTATION (VI../u) 19. LIVEBORN? IY•• or Noi 20. SEX IM or Fi 21. NAM! 01' CHILO :Z:Z. OELIVERY: v..;,..l w c...,.... y...... a.-h o_.,,.,. .. sill_,.,._, 23. OURATION 01' LABOR 24. 81RTH WEIGHT ILb•..O•.J 25. ABNORMALITIES AT 81RTH COMPLICATIONS Oft I'IIGMAMCY AND LABOI- DI!SCIIII IILOW WITH I'OOTNOTIS I 26. PRESENT CONOITION OF CHILO II( ri••ri '""' dar• 11rwi """"• 27. PLACE OF BIRTH ICuy «rwiH.,.pu«/1 COLL.4eOllltATIVC ,._CSCA.. CH (08.9) F'AGE 1 OF • ~K. ..INATAf.. lltCaCAllltCH ...ANCH, NINDe. NIM ~CTHa•aa. 14, ,..0. II.A.l54 OB-9 Reproduced at the National Archives
C:OL.II.·- I•It NU\E IHOSPITAL MO. INIMDB MO. lfRis RISfbRV tlkEA 1Y SUMMARY OF ACUTE ILLNESS CURING PAST 12 MONTHS SUMMARY OF BLOOD TRANSFUSIONS AND REACTIONS, II" ANY SUioiMARY OF PREVIOUS HOSPITALIZATIONS OTHER THAN PREGNANCY SUMMARY OF PREVIOUS X-RAY EXAMINATIONS OR TREATMENT PELVIC DISEASE PELVIC SURGERY OTHER SURGERY 1. CHILDHOOD DISEASES 2. TUBERCULOSIS 3. OTHER CHRONIC PULMONARY DISEASE 4. ALLERGY 5. URINARY TRACT DISEASE 6. SYPHILIS 7. HYPERTENSION RHEUMATIC FEVER OR RHO •• 9. VARICOSE VEINS 10. ANEMIA 11. CANCER 12. THYROID DISEASE 13. DIABETES 14. NEUROMUSCULAR DISEASE 15. CONGENITAL ANOMALY 16. OTHER SIGNIFICANT DISEASE 1. DIABETES 2. TUBERCULOSIS 3. HEART DISEASE 4. CANCER 5. NEUROLOGICAL CONDITION 6. PSYCHIATRIC DISORDER 7. CONGENITAL ANOMALY MULTIPLE PREGNANCY •• 9, OTHER SIGNIFICANT PAMIUAL HISTORY P' AST M8DICAL HISTORY NO YES COMMENT ON POSITIVE HISTORY I"AMILY HISTORY NO YES COMMENT ON POSITIVI! HISTORY COI.LA.OIIt4T1VC NC.CAIIICH (08-9) I'ACE 2 01' 4 ••MNATAL "UCAIIICM .IIIANCH, MINDa. NIH •CTHCSDA 1.&, MO. II.A.lSS OB-9 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 ,.
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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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ILL..'1ESS OR DISABILITY CODES (Con
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RECENT MEDICAL HISTORY (Con 1 t) OB
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OB-6 Past Medical History Form OB-6
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z PAST MEDICAL HISTORY (Interviewer
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DEF'll'UTION OF CODES PAST MEDICAL
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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
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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 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
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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 209 and 210: PRENATAL RECORD (Con 1 t) PRESENT P
Page 211 and 212: PRENATAL RECORD (Con 't) complete a
Page 213 and 214: PRENATAL RECORD (Can't) EVALUATION
Page 215 and 216: PRENATAL RECORD (Con't) GENERAL IDl
Page 217 and 218: OB-42 Past Medical History Form OB-
Page 221 and 222: -· 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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