Prenatal Record - National Archives and Records Administration

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PHS-3003·11 REV. 7-ea ~ RECORD OF CURRENT PREGNANCY 1. PATICNT &OCNTI ... IeATION INSTRUCTIONS: Fer each visit record und c-t•• 1. Unusual events, signs, symptoms. 2. Fir.din~s of physical examination. 3. Significant laboratory results and tests arderecl. d. Su:nmary of Consultations.. 5. Oiagnostts and impressions. 6. Medications pr.scribed and instructians giftlft. DATE AND SIGN EACH ENTRY. , cc ' r AT FIRST VISIT: SUhiiMARIZ& ANTII:PA"TUM COURSE TO DAT. 0.-t of H-lth, EclucaH-, .... Wei' 1 t•n. ·••• (OB-11) PAGE Publlc H-lth S...lco OF Reproduced at the National Archives II.A.324 OB-11
,... RECORD OF CURRENT PREGNANCY INSTRUCTIONS. B• s,.,. to: (I) D.scrib• conJitions witb fJMUifl• his1ory «rut otb.P umutull w.,.t.r, (2) lrotiictll• -.sult.r of....,. plrysic«l .,... .,;,...;oro fflllli•, (3) R•corti ...., tiit1po11is, (4) L.ist tUrJI UU.cmuory ..,..,.,;,..,,;ou fflllli•, t1rui ") lruiic«t• ,.JicatiOJU pHscrib•d arui sp•cilli ii'ISt.1'11CliOftS rivers. BE SURI! TO DATI! AND SIGN EACH ENTRY. s-11rin or iru:lwh copiu of c011•ullt11ioros obtlli,..tl. lilboNiory .-ports, tlrui otb.P p.n;,.,., .-cords. 0.-., He.lth, 1!4....tl........ w...... (08.11) PAGE OF ...... He.hh s...... Reproduced at the National Archives II.A.325 OB-11
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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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~~J2ITTIGN OF CODES (Co~~i~ued) FCa
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DEFINITION OF CODES (Continued) FOF
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DEF~~ION OF CODES (Continued) PELVI
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DEFTIHTION OF CODES (Continued) FQR
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ZEFT1ITTIO:i OF CODES (Con"'c:..!!U
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DEFINITION OF CODES ( Con~inued) FC
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!:: llil\41.0 ~ ~~ ~'~"'~ -N OB-9 -
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PRENATAL RECORD (Con 1 t) PRESENT P
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PRENATAL RECORD (Con 't) complete a
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PRENATAL RECORD (Can't) EVALUATION
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PRENATAL RECORD (Con't) GENERAL IDl
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OB-42 Past Medical History Form OB-
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-· 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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Page 295 and 296: Instructional Manual for Obstetric
Page 297 and 298: OB-45 Laboratory Record Form OB-45
Page 299 and 300: Reproduced at the National Archives
Page 313 and 314: DEFllUTION OF CODES LABJRATORY RECO
Page 315 and 316: DEFJNITION OF CODES (continued) FIE
Page 317 and 318: DEFINITION OF CODES (continued) FOR
Page 319 and 320: DEFINITIDN OF CODES (continued) FOR
Page 321 and 322: DEFTIUTION OF CODES (continued) FOR
Page 323 and 324: DEFINITION OF CODES (continued) FIE
Page 325 and 326: DEFINITION OF CODES (continuted) FI
Page 327 and 328: DEFTIHTION OF CODES (continued) FIE
Page 329 and 330: DEFTIUTION OF CODES (continued) FIE
Page 339 and 340: Instruction Manual for Obstetric Fo
Page 341 and 342: OB-11 Record of Current Pregnancy F
Page 343 and 344: CO~A·3C03·11 lltEV. '7·58 I. PAT
Page 345: RECORD OF CURRENT PREGNANCY (For Fo
Page 349 and 350: OB-46 Physician•s Clinic Record,
Page 351 and 352: COLR-1001-4e 4-a I. PATIENT IDENTII
Page 353 and 354: Instruction :\l:J.nual for Obstetri
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Page 357 and 358: SUMMARY OF HOSPITALIZATION FOR ANY
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Page 363 and 364: OB-47 Summary of Antepartum Hospita
Page 365 and 366: · COLIII-IOOa..7 (CHANGIED 2-8a)
Page 367 and 368: Instruction Manual for Obstetric Fo
Page 369 and 370: OB-15 Drugs in Pregnancy Form OB-15
Page 373 and 374: PH S.300S.18 ..... PATIENT IDENTIFI
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Page 377 and 378: PHI·IOOI .. 1B P"TIENT IOENTIFIC"T
Page 379 and 380: PATI~NT IDENTIFICATION OB-15 DRUGS
Page 381 and 382: ..... PHS .. 3003 ... 11 PATII!NT I
Page 385 and 386: DEFINITION OF CODES DRUGS lN PREGN
Page 387 and 388: Drugs in Pregnancy (08-15) Blank 0
Page 389 and 390: Drugs in Pregnancy (cont.} 2128 Par
Page 391 and 392: Orugs in Pregnancy (cont.) 4256 Hyo
Page 393 and 394: . Drugs in Pregnancy (cont.) 7154 S
Page 395 and 396: 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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