Prenatal Record - National Archives and Records Administration

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,.... ~Ha.!IOOS•I OBSTETRICAL ADMINISTRATIVE RECORD os-a ..J....f'M' Jc./ 1 ~~~" j 7-51 OAT TH S ,-O,_M INITIA HO.ITAL I~I:C:IAL NAMC ADOtiiCSS (SIHel & No.I OATil 011' 81 .. TH ( ::::JOR QPR ~Ott... lir!IIA"ITAL STATUS OAT& OP' L AT&ST HI.HC•T IC:HOOL MA..RtA•K Q"ADC C:OIIto4ftLCTCO ;:::s ::JM ::::JCL ::JW ::::JO QS!P occ:u~ AT ION -..~.oveR OUTI!TRICAL CLINIC PATIENTS OATit ~lfltST SCIIlN IN CLINIC IO:X .....NINe "'NY.CIAN OTHI!R PATII!NTS NA"''C AND AOD.. US 011' 0.8TCT,_ICIAN I OAT I: .. ATII:NT ~I"ST SIECN SPOUSE N-0: reo: STATIK 0" COUNTJIY Olf .IfilTH J HI:IGHT HI.HCST SCHOOf. QfltAOil locc""A'ftON IINOU8T..Y JGI:NI:.. A&. HI:ALTH co..-L.CTCD N-0: 1..."' aTA.TC 0 .. COUNTfltY 011' 81tiiTM JWO:IGHT FATHER JHO:ICIHT JWI:IGHT OF CHILD ''!,;'- s,.......J r HI.MIIST SCHOOL .JIAOC IOCC-ATION INDUST"'f C:O...L.ET'&D J·-"'""'" """'" o.,..,._, of H..tth, Eduutl.,. ..... W.II Pu .. lic H.eltt. S..•ice (OB-1) II.A.l6 AR-1 Reproduced at the National Archives
OB-1: OBSTETRICAL· ADMINISTRATIVE RECORD Instructions for Use par. 1 par. 2 This record was designed as the opening record for any gravida registered in the study. It notifies NINDB of a new study case, and should be submitted as soon after registration as is possible. It may also serve as a hospital form, and therefore includes items which are not needed for study use. Additional infor mation required locally may be recorded at the· bottom of the sheet. The.items listed below are needed for study use and must be completed before the form-is submitted. Other items are optional. 1 - Date this form initiated 2 - First day LMP 3 - Record numbers (including NINDB study number) ~ - Name (including mai~en name) 5 - Address 6 - Date of Birth 1 - Present Age I ; '• 8 - Race 9 -Marital Status 10 - Religion 11 - Date first seen by clinic or private obstetrician Par. 3 Comments concerning each of the above items are enumerated below: 1 - This date should be the date on which the gravida is selected as a study case. For many hospitals it will be the same as the date shown in item 11 (date first seen). All dates should be recorded.n~rically~ in the order month/day/year. II.A.l7 AR-1 Reproduced at the National Archives
Page 1 and 2: NINCDS COLLABORATIVE PERINATAL PROJ
Page 3 and 4: NINCDS COLLABORATIVE PERINATAL PROJ
Page 5 and 6: INTRODUCTION DOCUMENT OBJECTIVES AN
Page 7 and 8: Forms The first forms used in the s
Page 9 and 10: Reproduced at the National Archives
Page 11 and 12: selection. A n1n was used for patie
Page 13 and 14: , researcher is more likely to look
Page 15 and 16: TABLE 3. Abbreviations for Person,
Page 17 and 18: TABLE 4. Definition of Person, Time
Page 19 and 20: TABLE 4. Definition of Person, Time
Page 21 and 22: CONTENTS AR-1/0B-1 OB-2 OB-3 OB
Page 23 and 24: AR-1 Obstetrical Administrative Rec
Page 29 and 30: DEFINITION OF CODES {Continued) FOR
Page 31 and 32: ... 1;:: I ~ .J.I'40JI.!9d jl5 !
Page 33 and 34: ADMINISTRATIVE RECORD MANUAL PHS-30
Page 35 and 36: ADMI!liSTRATIVE RECORD ;fl.A.TI.TUA
Page 37: -· IID'~7-- '·"'-- ':!e- ~ l·-~
Page 41 and 42: Par. 3 10 - Religion. Record as Cat
Page 43 and 44: OB-2 Reproductive History Form OB-2
Page 47 and 48: COLIII:•IOoa-& ,.., REPRODUCTIVE
Page 51 and 52: DEFTIITTION OF CODES (Continued) FI
Page 53 and 54: 1 Reproduced at the National Archiv
Page 55 and 56: R~PRODUCTI\~ HISTORY (Con't.) C3-2
Page 57 and 58: REPRODUCTIVE HISTORY (Con•t.) C3-
Page 59 and 60: OB-3 History Since Last Menstrual P
Page 63 and 64: eoL"-aooa.a ACV. n-et • HISTORY S
Page 67 and 68: DEFINITION OF CODES (Continued) FOR
Page 69 and 70: DEFJNITION OF CODES (Continued) FOR
Page 71 and 72: "' 1: : ~~ :; "':J. !~ ~ ~ :~ ~ ; :
Page 73 and 74: HISTORY SINCE LAST 1-ENSTRUAL PERIO
Page 75 and 76: HISTORY SINCE ~T MENSTRQ~ P~RIOD {C
Page 77 and 78: OB-4 Gynecological History Form OB-
Page 81 and 82: COL.,.-aaaa-4 RIEV. tt-11 • GYNEC
Page 83 and 84: DEFINITION OF CODES GYNECOLOGICAL H
Page 85 and 86: DEFINITION OF CODES (Continued) FIE
Page 87 and 88: '? I~ 1: :1\ j; t:: t; ....J 7 ,.
Page 89 and 90:
GY1~F..COLOGICAL HISTORY (Con't.) O
Page 91 and 92:
08-5 Recent Medical History Form 08
Page 93 and 94:
Reproduced at the National Archives
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
DEFINITION OF CODES RECENT MEDICAL
Page 101 and 102:
DEl!'INITION OF CODES (Continued) F
Page 103 and 104:
DEFINITION OF CODES (Continued) FOR
Page 105 and 106:
Page 107 and 108:
ILL..'1ESS OR DISABILITY CODES (Con
Page 109 and 110:
Page 111 and 112:
RECENT MEDICAL HISTORY (Con 1 t) OB
Page 113 and 114:
OB-6 Past Medical History Form OB-6
Page 115 and 116:
Page 117 and 118:
z PAST MEDICAL HISTORY (Interviewer
Page 119 and 120:
Page 121 and 122:
DEF'll'UTION OF CODES PAST MEDICAL
Page 123 and 124:
DEF'INli'ION OF CODES (Continued) F
Page 125 and 126:
DEFINITION OF CODES (Continued) u.
Page 127 and 128:
DEFINITION OF CODES (Continued) FOO
Page 129 and 130:
Page 131 and 132:
PAST HEDICAL HISTORY (Con't) Item 1
Page 133 and 134:
HISTORY TAKEN BY PAST MEDICAL HISTO
Page 135 and 136:
OB-7 Infectious Disease and System
Page 137 and 138:
Page 139 and 140:
COLIII.•I00 ..7 ,... INFECTIOUS D
Page 141 and 142:
C:OLft-IOOa-7 1··· INFECTIOUS DI
Page 143 and 144:
DEFINITION OF CODES nlFECTIOO'S DIS
Page 145 and 146:
DEl''ll'IITION OF C:JDES ( Conti:::
Page 147 and 148:
i i :a :: ·• 1: !: ! I! ::
Page 149 and 150:
l!:i i!;T!IJIJ;: IIJ;;:..f,;:l·: .
Page 151 and 152:
INF~TIOUS DIS~S~ ;~D SYSTEM REVIEW
Page 153 and 154:
OB-8 Repeat Prenatal History Form O
Page 155 and 156:
Page 157 and 158:
I. ftATIIMT IDfNTIPICATIOM REPEAT P
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
DEFINITION OF CODES (Continued) FIE
Page 165 and 166:
~ :: : j: ~ : I~ =r ; Ia ~ ~ !~ ;
Page 167 and 168:
,;.-~ 1•1. 1J;,.... - ~ .. u;W'o'
Page 169 and 170:
OB-9 Prenatal Record Form OB-9, Pre
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
C:OL.II.·- I•It NU\E IHOSPITAL
Page 179 and 180:
•• 'HISTORY NO. diRIRXL IXXMI l
Page 181 and 182:
Page 183 and 184:
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:
Page 195 and 196:
ZEFT1ITTIO:i OF CODES (Con"'c:..!!U
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
DEFINITION OF CODES ( Con~inued) FC
Page 203 and 204:
Page 205 and 206:
:t , I~ I ~ It II! I~ ::: .. ~ .. ~
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:
Page 221 and 222:
-· eoL"-aooa-..a 08-42 PAST MEDICA
Page 223 and 224:
Page 225 and 226:
Page 227 and 228:
Page 229 and 230:
Instruction Manual for Obstetric Fo
Page 231 and 232:
OB-43 Initial Prenatal Examination
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
COL ..-3008-41 UIIYe 10.U) 1. PATIE
Page 239 and 240:
Page 241 and 242:
DEFINITION OF CODES miTIAL PRENATAL
Page 243 and 244:
Page 245 and 246:
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 253 and 254:
Page 255 and 256:
Page 257 and 258:
I, I'ATIENT IDENTI,.ICATIDN OB-43 I
Page 259 and 260:
OB-10 Return Visit and Laboratory R
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Page 263 and 264:
Page 265 and 266:
Page 267 and 268:
Page 269 and 270:
Page 271 and 272:
DEFTIUTION OF CODES (Continued) FOR
Page 273 and 274:
DEFINITION OF CODES (Continued) FOB
Page 275 and 276:
Page 277 and 278:
4/16/61 OB-10 RETURN VISIT AND LAB
Page 279 and 280:
~"........ ,... ~,_~.a., RETURN VIS
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OB-44 Prenatal Observations Form OB
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Page 285 and 286:
..... C:Ol..llt-IOOa-44 1. PATIENT
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Page 289 and 290:
:FDRMS 03-10 DEFINITION OF CODES (C
Page 291 and 292:
DEFINITION OF CODES (Continued) ~·
Page 293 and 294:
Page 295 and 296:
Instructional Manual for Obstetric
Page 297 and 298:
OB-45 Laboratory Record Form OB-45
Page 299 and 300:
Page 301 and 302:
Page 303 and 304:
Page 305 and 306:
Page 307 and 308:
Page 309 and 310:
Page 311 and 312:
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 331 and 332:
Page 333 and 334:
Page 335 and 336:
Page 337 and 338:
Page 339 and 340:
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:
Page 369 and 370:
OB-15 Drugs in Pregnancy Form OB-15
Page 371 and 372:
Page 373 and 374:
PH S.300S.18 ..... PATIENT IDENTIFI
Page 375 and 376:
.... PMS•3003•18 PATIENT IDENTI
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 383 and 384:
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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