Prenatal Record - National Archives and Records Administration

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PATIENT IOt:NTI I"ICATION OB-15 DRUGS IN PREGNANCY -I COD!: A- TAKEN 1 DAY ONLY 8- TAKEN 1-7 DAYS C - T AK!N MOR! THAN 7 DAYS D- TAKEN UNKNOWN TIME AHTI-IHFECTIVES ANTIBIOTICS, BACTERIAL 1001 chloramphenicol. • • • • • • • • • • • • • • • • • • • D 1002 erythromycin • • •. • • • • • • • • • • • • • • • • • • I 003 furadantin ••••• • • • • • • • • • • • • • • • • • • • D 1004 penicillin (all derivatives) • • • • • • • • • • • • • 1005 streptomycin ••• , ••••••••••••••••• • D 1006 tetracycline •••••• • • • • • • • • • • • • • • • • • D ~~:: ~~~;~!.. ..... ..... ..... .... ~~-~ ~~~;~!..................... D SULI'ONAMIDES 1007 sulphlsoxazole (Gantrisin) ••••• • • • • • • • • D 1008 sulfadiazine • • • • • • • • • • • • • • • • • • • • • • D 1009 sulphamethoxypyridi~zine (Kynex) ••• , •• •. 0 ~~:: ~~j:y~..................... 0 ~~:: ~~~i~y!. • • • • • • • • • • • • • • • • • • • • D MISCELLANEOUS 1010 Flagyl (~etronidazole)................ 0 DDDDDDDDDDDD .DDDDDDDDDDDD ~DDDDDDDDDDDD ~DDDDDDDDDDDD EDDDDDDDDDDDD !DDDDDDDDDDDD 3DDDDDDDDDDDD DDDDDDDDDDDD DDDDDDDDDDDD DDDDDDDDDDDD DDDDDDDDDDDD DODDDDDDDDDD DDDDDDDDDDDD . 0 0 o·oD D D D D D D D 1011 grls-fulvin ••••••••••••••••••••••• ~ DDDDDDDDDDDD 1012 INH(Isaniazid) •• ••••• ••• •••••••••• D E DDDDDDDDDDDD 1013 Mondelamine •••••••••••••• "'"'"'' i DDDDDDDDDDDD 1014 mycostatln ••••••••••••••••••••••• ! DDDDDDDDDDDD 1015 PAS(p-aminosalicylicacid) ••• ,,,,,,.,, D $ DDDDDDDDDDDD 1016 quinine .......................... D 1DDDDDDDDDDDD ~:~~~~~;~!..................... ~ ODDDDDDDDDDD ~~e:~~~;~!••••••••••••••••••••• 0 l DDDDDDDDDDDD OIEPA~TMKNT 011" HW:Al..TH, IIOUCATION AND W.L ..&RK ~U.LIC HCAL.TH S&ftVICK II.A.352 OB-15 Reproduced at the National Archives
.... PMS•3003•18 PATIENT IDENTIFICATION OB-15 DRUGS IN PREGNANCY- II CODI: A- TAICIN I DAY ONLY I- TAlC IN 1-7 DAYS C- TAKEN MORI THAN 7 DAYS D- TAKIN UNKNOWN TIMI ANALGESICS RELAXANTS, ANTIARTHRITIC$ SEDATIVES, ANTICONVULSANT$ ANALGESICS 2017 Aopirin..... • • • • • • • • • • • • • • • • • • • • • D DDDDDDDDDDDD 2018 codeine•••••••••• • • • • • • • • • • • • • • • • DDDDDDDDDDDD 2019 Oarvon (dextropropoxyphene)•••••••• • • • • D a DDDDDDDDDDDD 2020 Zactirin (ethoheptozine)••••• • • • • • • • • • • D. ~ DDDDDDDDDDDD ~h~: ~s~~~:!..................... 0 i DDDDDDDDDDDD ac RELAXANTS, ANTIARTHRITIC$ ... z 2021 phenylbutazone•••• • •• • • • • • • • • • • • • • • D ~ DDDDDDDDDDDD 2022 Robaxin (methocarbamol) • • • • • • • • • • • • • • ; ... DDDDDDDDDDDD 2023 Soma (corioprodol) • • • • • • • • • • • • • • • • • • D : DDDDDDDDDDDD 2024 Zoxozolamine (Fiexin)•• • • • • • • • • • • • • • • D DDDDDDDDDDDD ~h~ ~~~~~y! __.______________ ._. _D . DDDDDDDDDDDD SEDATIVES, AHTICOHVUUANTS 2025 chloral hydrate, •••••• • • • • • • • • • • • • • • D DDDDDDDDDDDD 2026 dilantin••••••• • • • • • • • • • • • • • • • • • • • D DDDDDDDDDDDD 2027 Dorlden (glutethimide) •• • • • • • • • • • • • • • • D DDDDDDDDDDDD 2028 Noludor (methyprylon) •• • • • • • • • • • • • • • • D DDDDDDDDDDDD 2029 pentobarbital (Nembutal) • • • • • • • • • • • • • • D DDDDDDDDDDDD 2030 phenobarbital ••• , • • , • • • • • • • • • • • • • • • D 8 EDDDDDDDDDDDD 2031 Plocidyl (ethchlorovynol) • • • • • • • • • • • • • • D ~DDDDDDDDDDDD 2032 Seconal (Secobarbital).~.,,,.·. • • • • • • • • D !DDDDDDDDDDDD 2033 Volmid (ethinomote) , , , ••••• • • • • • • • • • D sDDDDDDDDDDDD ~h-~ ~S~I~y!. .................... D ~DDDDDDDDDDDD ~h.-: ~s~~Y!... _.......... ....... 0 DDDDDDDDDDDD ~h.-: ~s~:~~Y!....... _. ............. 0 DDDDDDDDDDDD Oll~A.. TMilNT Ofl' HllAL.TH. EDUCATION AND WIEL~A.. E a.ea PAGE ----- PUaL.IC HEALTH l&ftVIC& ZOFt 08-15 II.A.353 OB-15 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 183 and 184:
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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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:t , I~ I ~ It II! I~ ::: .. ~ .. ~
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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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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
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 331 and 332: Reproduced at the National Archives
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 and 346: RECORD OF CURRENT PREGNANCY (For Fo
Page 347 and 348: ,... RECORD OF CURRENT PREGNANCY IN
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
Page 355 and 356: OB-12 Summary of Hospitalization fo
Page 357 and 358: SUMMARY OF HOSPITALIZATION FOR ANY
Page 359 and 360: SUMMARY OF HOSPITALIZATION FOR ANY
Page 361 and 362: ':.::-•••suMMARY OF HOSPITALI
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: PH S.300S.18 ..... PATIENT IDENTIFI
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
Page 397 and 398: Drugs in Pregnancy (cont.) 9169 917
Page 399 and 400: Drugs in Pregnancy (cont.) 9949 995
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Prenatal Record - National Archives and Records Administration

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