Prenatal Record - National Archives and Records Administration

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Instruction Manual for Obstetric Forms OB-42 PAST MEDICAL HISTORY I. Purpose of form To record details of patient's previous medical and surgical history up to time of interview. II. General Instructions A. Record know.1 diseaees and surgical procedures only. Do not use this form for symptom review. B. Give particular emphasis to medical history just prior to, and since onset of this pregnancy. C. Record appropriate details, such as dates of onset, duration, severity, place of hospitalization, operations performed, non-routine treatment, etc. D. If history for the item is negative, mark the box labeled, "None." E. The summary (Item 17) provides a means for flagging certain important conditions. It is incomplete and should not be used as a sole guide to obtaining past medical history. Ill. Specific Instructions Item Number 2. Date. Record the date history is obtained from the patient. 3. Patient's history was. Mark the appropriate box. When the entire past medical history is abstracted from hospital records without patient interview mark "'Abstracted from other records." 4, 5. History taken by. Record the first initial and last name, and the title or position of the physician obtaining the history. 6. Childhood diseases. Record history of the usual infectious diseases. Pay particular attention to the occurrence of such diseases in the three months prior to or since the onset of this pregnancy. 7. Cardiovascular. Record history of rheumatic fever, St. Vitus dance, chorea, or other syndromes p o s s i b 1 y associated with heart involvement. Record any details of diagnosed or suspectedheartdisease, chronic hypertension, or vascular disease. Item Number 8. Respiratory. Record history of chronic respiratory disease, such as tuberculosis, asthma, bronchiectasis, etc. Acute infectious respiratory diseases are considered significant only if requiring medical care or hospitalization. 9. Digestive. Record history of gastro-intestinal disease, such as peptic ulcer, cholecystitis, cholelithiasis, regional ileitis, and chronic ulcerative colitis. Diarrhea of unspecified origin is considered significant only if requiring medical care or hospitalization. 10. Gynecological and venereal. Record medical or surgical history of gynecologic disorders. A history of infertility is considered significant only if work-up such as endometrial biopsy, Rubin' s test, hysterosalpingography, etc. is carried out. Record any history of veneral disease. 11. Other surgery. Record the details of surgical procedures not listed more appropriately elsewhere on this form. 12. Renal and urinary tract. Record history of renal and urinary tract disease or surgery, such as glomerulonephritis, acute or chronic p yelo nephritis, cystitis, lithiasis, and nephrectomy. 13. Endocrine and metabolic. Record any suggestive or definite history of endocrine disorder. 14. Neuromuscular and psychiatric. Record any definite or suggestive history of disease of this system, expecially migraine, epilepsy, mental illness or retardation, or neuromuscular disorder. 15. Blood and transfusions. Record the history of anemia, iso-immunization, leukemia, or other disorders of the blood. History of whole blood transfusions is to be noted, along with dates of administration and reaction, if any. 16. other conditions. Utilize this space to record a history of disease or disorder not covered in the above items. Of especial importance are chronic diseases of the skin, allergies, trauma, malformations, neoplasms, and parasitic diseases. October 1962 Reproduced at the National Archives II.A.207 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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OB-9 Prenatal Record Form OB-9, Pre
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Page 177 and 178: C:OL.II.·- I•It NU\E IHOSPITAL
Page 179 and 180: •• 'HISTORY NO. diRIRXL IXXMI l
Page 181 and 182: Reproduced at the National Archives
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 221 and 222: -· eoL"-aooa-..a 08-42 PAST MEDICA
Page 227: DEFINITION OF CODES (Continued) FOR
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 253 and 254: Instruction Manual for Obstetric Fo
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Page 257 and 258: I, I'ATIENT IDENTI,.ICATIDN OB-43 I
Page 259 and 260: OB-10 Return Visit and Laboratory R
Page 271 and 272: DEFTIUTION OF CODES (Continued) FOR
Page 273 and 274: DEFINITION OF CODES (Continued) FOB
Page 277 and 278: 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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