Prenatal Record - National Archives and Records Administration

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Reproduced at the National Archives oat a Items RPfPrt>nclnQ form QR-42, Past Me•11 c~l ~tstorv 01\TA ITEac TO tt?s •• nB-47 112& •• nB-47 t117 •• nB-47 ll?B •• nR-4? 11?9 •• 08-4? t13o •• nu-42 t111 •• nB-4? 113:.! •• nB-42 un•.no-47 1134 ••no-47 1135 ••••••• 49R7 •••• YAR tS 17 17 11 1#; 17 17 17 17 tl' 2 lfF.M JN F')IH4 CARO NIIM FQ0'4 rn OHA Tf~14 NlMF. 0342 034? 034? 034? Ol4? 0342 034? 0342 034? 0342 0342 5R 5q 61) &1 62 61 &4 6S 66 67 6A 5" ~H H]ood and transfusions, SUllm!lry cod!! ~9 Blond and transfusions; ::~nemla 60 Blond and transfusions; ls:>f111munU:at1on 61 Rlood an::t transfusions; tr'!nsfustnns 62 Con11tions, oth!!r: SU'IIIIIArV Co1e 63 Con11t tons, oth!!r: :!ru~ se'l!';ltivttv 64 CnnrHtlnF'I!'l, ot tiP r: allerqy 65 CnnrH t tons, otner: lllaJform!ltlons 66 ConrHtions, othl"rl oarasitle ~tse8se 67 Htstorv, other sl~nlflcant AO Blank 11\6 Prenatal vtslts, tot•l nuwtDer 1-f 1-f ;. • ...... \0 00 @ I N""'
-· eoL"-aooa-..a 08-42 PAST MEDICAL HISTORY :::;=.~c~:~:;e:~.d:~=~~~:~L~;i:.~z=~·~u:'~~qh~ ~~· approJ:Ciate. 2. DATE 4. HISTORY TAKEN BY I. PATIENT IDENTIFICATION Ma. 3o.&PA TIENT"S HISTORY WAS 5. I LE OR POSI 'ION 0OeTAIM&D ua111• THII POtt ... •••TttACTEO P'ttOM OTHII.Jt MCCORD I --: 6. CHILDHOOD DISEASES QNONit 7. CARDIOVASCULAR 0NONI: ' I17.SUMMARY I IQIIu•&LLA 0MUMPI QHIEAIIIIT OISCASC o~~:~=~CI£NSION 0"HCUMATIC "'lEVIER QVASCULAR OISCASIE I. RESPIRATORY QNONI: 0 TUBCIItCULOSIS QASTHMA 0PNCUMONIA I. DIGESTIVE QNONI: QHIEPATITIS QCHOLIECYSTITIS. LITHIASIS OPIEP'!'IC ULCC.. 10. GYNECOLOGICAL AND VENEREAL QNONI: o:~::i~;ooae QINJI'IE.. TILITY QSYPHILIS QGONOfii.. HCA II. OTHER SURGERY QNONI: QOTHIE" ABDOMINAL SUfiiGIE,.Y 12. RENAL AND URINARY TRACT 0NONI: I QPYIELITIS I 0CYSTITIS IOQLOMO:IIULONO:PHIIITIS U. ENDOCRINE AND METABOJ-IC 0NONI! 14. NEUROMUSCULAR AND PSYCHIATRIC 0NONI: II. BLOOD AND TRANSFUSIONS 0NONI: I QTHVI'IOIO DYSfi'UNCTION I oo•••cTU MELLITUS I I 0MIG.. AINC I 0MCNTAL II.LNCSS I QCONYULSIYIE OISORDIEJII I 00THI:II NI!UII'>LOQIC OISIEASE IOANO:MIA : CJISOIMMUNIZATION 16. OTHER CONDITIONS (Sidn. All•r.,, r,._., NeoplaerrM, Pe,...Hee, etc.) 0NONI: "·LAY EDIT BY I OTIIANIP'USION I0 DIII:UG S&N!ITIYITY I00THI:II .LLI:IIGV I OMALP'OIIMATION• I 0 PA.. A&ITIC DIS& AS& I II. O~l~~~:f~~",.NJ"T ! LISTED ABOVE COLLAaOIII:ATIY& "IEIIEA.. C:H PE..INATAI,. R.EI&AR.CH .RANCH, NINDe, NIH aiiETHIIESDA I .a, MO. 08-42 Reproduced at the National Archives II.A.l99 OB-42
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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.
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DEFINITION OF CODES (Continued) FOO
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PAST HEDICAL HISTORY (Con't) Item 1
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HISTORY TAKEN BY PAST MEDICAL HISTO
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OB-7 Infectious Disease and System
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COLIII.•I00 ..7 ,... INFECTIOUS D
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C:OLft-IOOa-7 1··· INFECTIOUS DI
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DEFINITION OF CODES nlFECTIOO'S DIS
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DEl''ll'IITION OF C:JDES ( Conti:::
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i i :a :: ·• 1: !: ! I! ::
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l!:i i!;T!IJIJ;: IIJ;;:..f,;:l·: .
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INF~TIOUS DIS~S~ ;~D SYSTEM REVIEW
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OB-8 Repeat Prenatal History Form O
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I. ftATIIMT IDfNTIPICATIOM REPEAT P
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~ :: : j: ~ : I~ =r ; Ia ~ ~ !~ ;
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,;.-~ 1•1. 1J;,.... - ~ .. u;W'o'
Page 169 and 170: OB-9 Prenatal Record Form OB-9, Pre
Page 171 and 172: Reproduced at the National Archives
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 193 and 194: DEFINITION OF CODES (Continued) FIE
Page 195 and 196: ZEFT1ITTIO:i OF CODES (Con"'c:..!!U
Page 197 and 198: DEFINITION OF CODES (Continued) FOR
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 219: Reproduced at the National Archives
Page 229 and 230: Instruction Manual for Obstetric Fo
Page 231 and 232: OB-43 Initial Prenatal Examination
Page 237 and 238: COL ..-3008-41 UIIYe 10.U) 1. PATIE
Page 241 and 242: DEFINITION OF CODES miTIAL PRENATAL
Page 247 and 248: DEFINITION OF CODES (Continued) FOB
Page 249 and 250: DEF'INITION OF CODES (Continued) FO
Page 251 and 252: I ,rnrn:r s YIN.Ct:l S6¥:;~rn I
Page 257 and 258: I, I'ATIENT IDENTI,.ICATIDN OB-43 I
Page 259 and 260: 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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Instruction Manual for Obstetric Fo
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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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Instruction Manual for Obstetric Fo
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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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