Prenatal Record - National Archives and Records Administration

SUMMARY OF HOSPITALIZATION FOR ANY ANTEPARTUM CONDITION (Can't)
Items #9-#10, "Diagnosis" (Con' t)
of onset in the appropriate box.
Items #11-#13. "Therapy"
If therapy consists of observation or bed rest only, so indicate.
Record in the appropriate space any medical therapy the patient
received. List specific drugs, dosage, dates given, response to
medication, untoward reactions etc. If a surgical therapeutic procedure
is performed, describe it carefully and be sure to have the
anesthesia record completed.
Item #14. "Status of Pregnancy on Discharge"·
This is intended to distinguish between the status of the pregnancy on
discharge and the status of the condition for which the patient was
admitted. If the status of the pregnancy was unaltered by the conditi
for which the patient was admitted, or by therapy, check appropriate b
If for reason other than unchanged or terminated, specify the change i
such terms as "aborted", "suspected fetal death", etc.
Item #15. "Condition on Discharge"
This refers to the patient's status on discharge as far as the conditi
for which she was admitted is concerned. Check the appropriate box to
indicate whether in your opinion she is cured, improved, unchanged,
worse, or deceased.
February
(For Forms in Use April l
Reproduced at the National Archives
II.A.338 OB-12