Prenatal Record - National Archives and Records Administration

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PATIENT IDENTIFICATION OB-15 DRUGS IN PREGNANCY- V CODI!: A- TAKEN I DAY ONLY 8- TAKI!N 1.7 DAYS C - TAKI!N MORI! THAN 7 DAYS D- TAKI!N UNKNOWN TIMI! ANTIHYPERTENSIVES DIURETICS MISCELLANEOUS ANTIHYPERTENSIVES 5068 hydralazine (Apreooline), •••••• • • • • • • • • D 5069 reserpine••••••••• • • • • • • • • • • • • • • • • 0 ~~h~: ~:.~i~y~................. _.. _D ~:h~: ~:.~i~y~ ..............-...-.. 0 DIURETICS 5070 acetazolamide (Diamox) •••••••••••••• • -o 5071 ammonium chloride ••••••••• • • • • • • • • • D son b•n•droflum·•hiazid•. • • • • • • • • • • • • • • • • D 5073 chlarthalidone (Hygrotan) • • • • • • • • • • • • • • D 5074 chlorothiazide (Oiuril) •• • • • • • • • • • • • • • • D 5075 hydrochla~hiazide (Eodtix) • • • • • • • • • • • • • D 5076 Mercuhydrin •••••• • • • • • • • • • • • • • • • • • D 5077 trichloromethiazide (Naqua) •• , •• , • , , • • • D ~h~ ~~~i~y! __ .__________________D ~:h~ ~~~i:y~ _D MISCELLANEOUS ~~l~y~ •••• - •• - - •••• - ••• - - - - -.. • ~s~~~~Y! .................._...... 0 ~~~~:~...............--.... -... 0 ~:.~i~y! ..................-...... D ~~~y!................--....... 0 ~S~i~y!................... -..... D ~s~-:_;~y! ....................... _. 0 ~s::,~y! ....... ~ ................. D OEPA,.TMKNT 0~ HllAL.TH, II.OUCATION ANOWIE&..P'ARIE PUBL.IC HCALT..., SI[.. VICI[ DDDDDDDDDDDD DDDDDDDDDDDD 0 DDDDDDDDDDDD 2 • IU L DDDDDDDDDDDD .... c • = ... z IU DDDDDDDDDDDD :1 ... c DDDDDDDDDDDD .... . DDDDDDDDDDDD DDDDDDDDDDDD DDDDDDDDDDDD . DDDDDDDDDDDD . DDDDDDDDDDDD DDDDDDDDDDDD DDDDDDDDDDDD DDDDDDDDDDDD DDDDDDDDDDDD 2 0 • IU DDDDDDDDDDDD L ~ = DDDDDDDDDDDD •... DDDDDDDDDDDD :1 ... li DDDDDDDDDDDD c .... . DDDDDDDDDDDD . DDDDDDDDDDDD DDDDDDDDDDDD e ..ea ..-~~E9 08-15 II.A.356 OB-15 Reproduced at the National Archives
PATI~NT IDENTIFICATION OB-15 DRUGS IN PREGNANCY - VI CODE: A- TAKEN 1 DAY ONLY 8-TAKEN1-7DAYS C- TAKEN MORE THAN 7 DAYS D- TAKEN UNKNOWN TIME IMMUNillTIONS VAGINAL MEDICATIONS CONTRACEPTIVES IMMUNIZATIONS 6078 influ..,zo (polyvalent) , , •• , •• , , ••••• , , 6079 measles (ki lied) , ••• , , , , , , • , , , •• , , •• 6080 measles (live - oral) • , ••• , , , •••••••• 6081 polio (killed), , •• , ••• , , • , •••••••••• 6082 polio (live - oral) ••••••••••••••••••• 60P3 smallpox vaccine , , , , • , •• , , ••••• , , •• 608A tetanus • ••••••••••••••••••• • • • • • • Other (Specify) Other (Specify) VAGINAL MEDICATIONS 6085 F loraquin , , , , , , • , , , •••• , ••• • • • • • • 6086 Furocin , , , , , ••• , , , • , • , , , , , , •• , , • 6087 Mycostatin, , , , , , • , •••••••• , •• • ••• • 6088 Sporostacin , , , , , , • , , , •• , , , , , •• , ••• 6089 Triple Sulfa, , • , , , , , , , , , • , , , ••••••• Oth• (Specify) Other (Specify) CONTRACEPTIVES 6090 Oelfen , , • , ••••••••••••• • • • • • • • • • 6091 Emko,,,,,,,, •• ,, •• • • •• • • • • • • • • • 6092 Orthogynol , , • , , • , , , • , , , • , ••••••• • 6093 Preceptin , • , , , , , , , , , ••••• • • • • • • • • Other (Specify) ................................... Other (Specify) O&PAIItTMENT 0~ HKA~TH. •DUCATION AND WaL.II'AIItll PUBL.IC HaAL.TH ll:lltVICK DDDDDDDDDDDD D DDDDDDDDDDDD 0 DDDDDDDDDDDD D~DDDDDDDDDDDD D i.DDDDDDDDDDDD D~DDDDDDDDDDDD o;ODDDDDDDDDDD D~DDDDDDDDDDDD D DDDDDDDDDDDD DODD DODD D DODD 0 DODD D DODD D DODD D DODD ... oC D ~.. DODD !;; z DODD Ill :a D ... DODD ... D DODD oC D DODD D DODD .... PAG~ I OF 9 -ll8-1s Reproduced at the National Archives II.A.357 OB-15
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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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: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
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DEFINITION OF CODES (continued) FIE
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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
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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 and 374: PH S.300S.18 ..... PATIENT IDENTIFI
Page 375 and 376: .... PMS•3003•18 PATIENT IDENTI
Page 377: PHI·IOOI .. 1B P"TIENT IOENTIFIC"T
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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