Prenatal Record - National Archives and Records Administration

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C.JL.. •1.•10'JJ.. 9 1•59 EXAMINED I!Y !DATE (Mo.O•·Y•J 1. TEMP. :2. PULSE 13. I!LOOO PRESSURE "F I /MIN i I ~. NON-PREGNANT wEIGHT :s. PRES. weIGHT I'· HEIGHT I"ILVIC EXAMINATION 7. EXTERNAL GENITALIA II. BLEEDING _: .....__, Nor-1 :.None -Present =Vulvar Var~c••t•e• C From Utetua = Othe. =p,..,. Cervix w Vagi no. -Not Eva luoted =Other (Rectal, etc.) 8. INTROITUS -Nat Evaluatecl ~Normal 12. CERVIX Abnormal =N--1 = Urethrocele, Cystocele Abnormal ,..._Rectocele =Chronic Cyatic C.rvicitia =Old Perineal Lae~ration I:Eraaion =other ._ - Not Evajuated CE..nion =Polyp 9. V"GIN" :J Old Loc:erati on - Normal =Ott... "bnornool -:Nat Evol.,.tecl =Abnormality present other than voginitia 13 • UTERUS ..._,Not Evaluated :.Nar....l 10. VAGINITIS -Abnormal =None =,.., Preaent :-" Contenitol Anomaly ..- Trtchomonaa ::Other .....,Nat Evoluatod =Monilia 1 •• ADNEXA =Non.Spectfic ....... N....-1 =Other -Abn•-• =Not e ........... IVAI.UATION OP PI!LVIS .......,,__.. ~Excessive Tenderneaa -Other -.-Not e ........... 15. DIAGONAL CONJUGATE 16. SACRUM 17. SPINES 18. ARCH =Not R..ched ~Nar-•c- =Not Pr anti rwnt 1""1Normal =:Reached at--- CMS. :Flat C P"omineftt A Wide i=A........... ?1 Norrow 19. Si·lachiol 120. Posterior So9ittol 21. ..._criatol 22. SIDEWALLS SACROSCIATIC NOTCH 23. "SYMMETRY r~· OTHER PELVIC ABNORMAUTY =c-..90"' =None .....,N_ - PreHnt ;:::::; Pre..nt SUMMATION -- ....~- ~Di..rgent =Average C:Wide ::Narrow 26. X·RAY PELVIMETRY !If Dort•) 25. INLET !28. MIDPELVIS 29. OUTLI!T Marpheloty fTyp•) =:Adequate =Adequate OB c.,ju90,.: CMS. ! ::c--.."· lm.tapinoua: CMS. =Contractod =Controctecl Tr--roe Inlet: CMS. 27. LIST BY BOX NUMBER AND DESCRIBE ANY ABNORMAL FINDINGS NOTED PRESENT ABOVE. COL..L.A80AAT1VIt AIISEA .. CH (08-9) P"GE 3 OF ~ _.II: lit IN A TAL. AlES IE AflltCH ... ANCH, NINO •• NIM SIE THilSDA 14, ~Oa II.A.l56 OB-9 Reproduced at the National Archives
•• 'HISTORY NO. diRIRXL IXXMI ltioA 1. I!Y!S 7. BRI!ASTS ..._, ON·-· 8'"'·-·- Other •• ...,.._, 8,.,.. C!N•-1 QNetl!...._ ... Other 'CJNetl... lueteol 2. MOUTH NIJfPL.IS L..J"'·-· ........... ··--· rl C:..lee In T-+t §T_.D~ Me.., T•th Mini,. l!delltul Other C!Netl!...luetM C!N•-1 §'"........ ~_. CJNetl¥e11MtM '· ABCOMI!N Cl Her..I 3. U,t!R RI!SPIIIIATOIIIY ..__, Altll·-· C!N•-1 §'"'·--· llleiH ··--· --· ....... t:!=· 0...••'"-•n Otlw CJNetl!veiiMtM LYMPH NODI!S CJN.-1 C! .......ltl• o...,.. ,.,•• :;:; o,.,.,,... s••• (Otkr ,._ a,.,;,J UI-J CJNeti!...IIMteol 10. I!XTIIII!MITII!S CJN•-1 •~a--• ........... V•te••"•• §.,........ &..-11, =·..· ~.... Ge_ll, ...... Other :::JNetl!veiiMtM C!Netl!...l_.,. 11. OIIITHOJfi!CIC DI!Jfi!CTS C!N C!N•-1 ........... oc..... ,..._ ,....,Netl!wlueteol , Ge-.11.....,.••..-. 12. SKIN §e......-"' an. 1.e11e CJNer...l ~,Neolule s. THYROID ......"' ....._, ...., Jcoulld Ice C!NetE... IIMteol ~R..h 6. HI! ART 8 L.eei• CJN•-1 A......_ I 8:;;:;1er """" Rh,.._ ::::NetE... Iueteol Or'- ON•E-1...... 13. OTHER SYSTEM NOT EVALUATED ABOVI! Q ABNORMAL (D••m•• s,.,.,. ....4"-lillf &.law) 1.&. LIST BY BOX NUMBER ANO DESCRIBI! ANY ABNORMALITY NOTI!D ABOVE 15. RECORD ANY CLINICAL DIAGNOSIS MAO! DA Tl! 01' ONSI!T DO NOT USE COI.r..A•o•ATIV......AIIICM ~C..tNATAL. JIUaAIICM MANCMt MINOa. NIM •aTHUDA ,._ MO. II.A.l57 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
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DEFINITION OF CODES (Continued) u.
Page 127 and 128: DEFINITION OF CODES (Continued) FOO
Page 129 and 130: Reproduced at the National Archives
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
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: C:OL.II.·- I•It NU\E IHOSPITAL
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 -
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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