Prenatal Record - National Archives and Records Administration

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COLR-3003-4A .... I. PATIENT IDENTII"ICATION 08-43 INITIAL PRENATAL EXAMINATION PAGE 1 Z. DATE 6. THIS EXAM 7. FilE•&>< AMI""'" -av WAS I I 0 CONOUCTilD iio. 1 Dey 'Pear 1 I USIN. TNia 4. EX A MIN ED BY '0Rtrol I. TITLE 011 POSITION ---. I 0 OTN~II •. 9 :::.-:-.::'" 9 ~~.:,--::~. 5. TITLE OR POSITION 2 (See --- M•ual) •&YIIWCO R~YI~W~D (lniUIOI All Ch-1..) 10. NON· PREG. I"· WEIGHT •• •• HEIGHT IIZ. PULSE GENERAL EXAMINATION 1•. GENERAL APPEARANCE 0 ...... 0 NOJU..... L D ACUTELY ILL Ox ___ 1__ _1 0 NOT EVAL. 0 CHftONICALLY ILL ox 15. SKIM 0 LESION ONOitWAL ox 0 NOT EYAL. ox 16. EDEMA ONONE ox 0 NOT EVAL. ox 11. LYMPH MODES 0 NORWAL 0 rr. NOT ox EVAL. I e. EMT AND MOUTH 0 NOT OON& (•aplllln) QoaM'I'O•ATU OoTMCII 0 HANDS 0"'&T1eiAL 0 A.BOOMINAL WALL o:::~ .....,.. ENLARGED LOCALLY ::::J ENLARGED GENERALLY 0 "'OAWAL 0 ~':.~';.~':;'AT ION 01' ox 0 NOT IVA'-• 0 OTHIII INPLAWWATION .. 0 NIARIN. IW~A.IAMIUIT 00TMU II. EYES 0NOttMAL o. 0 NOT I VAL. ox OJAUNOICC zo. THYROID AND THYROID FUNCTION O"OitWAI.. AT Ox CI.UIICAI. EXAM o:~~~~~~~~O:T::.:·OIO 0 NOT I VAL. AT EXAhll. ox Zl. BREASTS ::J Ow••• NORWAL 0. rl NOT I VAL. w u. LUNGS ONORfrroiiAL ox 0 NOT IYAL • Z3. HEART QNORMAL ox 0 NOT IYAL. ox z•. eXTREMiTieS O•••"MA&. euMa O tNYHTI.D Nl"k&8 OoT•a D:='.':~T aueNCTU Do..,.• ONORWAL VAitiCOaiTIEa, 0 Ox WODEIItATI CJ NOT IYAL • • ox Z5. NEUROLOGICAL .,._ avtoc•cc ~ NOitMAL 0 :::~::-:.&. 0 f!W' HUit.~HICA~ Dt-.aa :J NOT IYAI..o 21. FUNDUSCOPIC m
COL ..-3008-41 UIIYe 10.U) 1. PATIENT IDENTII'ICATION 08-43 INITIAL PRENATAL EXAMINATION OBSTETRIC EXAMINATION 2. ABDOMEN (except uteftle) QNOitMAio. O••..oaMAL MAee 0 CYA TlttDI.ItMI.S8 ox 0 NOT EYALe 0 h •• •• •• MEitMIA 0 AaOOMIMAL TEM0EitME88 QoTNER l. CORPUS UTERI 0 SIZE MOT CONI'ATI.LE 0 UTCitiME TEMOEitNES. WITH OATES QNOitMAL II"Oit OX WI.I:AS GI.STATIOM DMOT 'IYAL. • w MOitNAL 0 0 NOT EYALe 0 4. EXTERNAL GENITALIA YULYAit VAitiCOSITIIS OTMEit OoTNI.It 5. INTROITUS 0 UOCTMOO«•• 0 ltiCTOCEl.C QMOitNAI.. 0 MOT CYAL. D CTSTOCCLC 6. VAGINA 0 vAeiMITis QoTNIIt gMOitMAL. 0 MOT CYALe 0 7. CERJrx UTERI •I..EIDIMe •tTl 0 o•o ••«UTION D ClltVICITIS 0 NOT IVAI,.. 0 •u:CDJNe SITI .. 0 OILATID OR CP'rACED OoTMCit I. ADNEXA 0MA88 OoTMCIIt QNORMAI.. O•oT IY.t.L • CLINICAL PELVIC MENSURATION I 0NOT OONO:(Expl•ln) --T--t PAGE 2 I .\lark (X) All apprupft•ta bo••• .,.d' de•cribe .ny poeUlve llnd.ina• •t riljht. 10. DIAliDNAL I;DNJUliATI: 11. SPINES IZ. SACRUM 13. SACROSCIATIC NOTCH 14. SIDEWALLS I Ci AVIItA.I CUitVI. QAYEitAGI C••~t•a..a..IL I 0 MOT ...OMINI NT ct::!CMCD AT .... I 0 0 0 I OP'I..AT O••ltltOW 0 CONVUIGIMT Q lti:ACMCD AT i c;:J "'OMINCMT 0 I I I CWO ANGUI..ATilD OIVCRGilNT I Ow•oE 0 ::J NOT CVAI... • • • tilt 11. '" fi:HTUIII:IUJU~ II. OTHER PELVIC SUMMATION AIHORMALITY 15. SUB PUBIC ARCH If. INLET 120. MID PELVIS 21. OUTLET 0NONI 9 AOIQUATC ~ AOIOUATil ~ ADI.QUATI O•vERAec ONAitltOW CWO 0 0 I 17. POST. SAG. OUTLET 0 ASYMMI:TitY O•oltDI.It• o oooo... -I 0 0000&0· .... 2 •• 2 • at done) 1 I..INI 1 \.INC 1 \.INC I Owtoc z QOTMCit 0 COMTRACT• 0 COIItTitACTED D COMT,.ACTI:D 23. CON• 24. AltJIIIIOaiNATI: SUI..TATION DATE OP" 22. DIAGNOSTIC IMPRESSIONS (Record.,, lndu.un, ol>ererrlciiiJ SOUGHT OMtiiT I I I 25. LAY EDIT ,26. MED !lwtTM . :27. MEDICAL ; Zl. TITLE OA BY EDIT T ~:::~TAL 9i21!t,Y.l... : EDIT IIY . : POSITION COLL.A80fii:ATIVR RIEIIEAIItCH Pa.. INATAL .. IESIEAIIII:CH B .. ANC:H. NINO•• NIH {ltCV • 1 O.aa f :~:~ 08-43 BETHESDA 14. MD. !IeA.215 OB-43 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.
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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'
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OB-9 Prenatal Record Form OB-9, Pre
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C:OL.II.·- I•It NU\E IHOSPITAL
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•• 'HISTORY NO. diRIRXL IXXMI l
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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 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 219 and 220: Reproduced at the National Archives
Page 221 and 222: -· eoL"-aooa-..a 08-42 PAST MEDICA
Page 229 and 230: Instruction Manual for Obstetric Fo
Page 231 and 232: OB-43 Initial Prenatal Examination
Page 235: Reproduced at the National Archives
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
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
Page 279 and 280: ~"........ ,... ~,_~.a., RETURN VIS
Page 281 and 282: OB-44 Prenatal Observations Form OB
Page 285 and 286: ..... 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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