Prenatal Record - National Archives and Records Administration

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Reproduced at the National Archives nata Ite~s RPterPn~in~ for~ ns-2, Penrndo~ttvP Hfstorv 01\TII Tfl"''l ITEM JN CARO TO F'JRI4 NIIM fROM TO DATA TfFM NA"'f: 49112 •••• "AR t-2 46 47 P~rttv, oreqn~n~i~s, total nu~bPr of nrfor non abortion of 20 wks aestAtfon or ~reatPr 49A3 •••• VAR 2 4R 49 Deaths, tot~l nu~her nf orior orenatal 49114 •••• VI\P 2 50 51 Lfvebfrtns, total nu~ber of Prior 5248 •••• VAR t 1 l8R JAB Premature: hirtns, total numoer Prior to current ore~nancv 5249 •••• VAR 2 ~~q 3A9 F'Pt~l dP~th~: (~borttonl At less th~n 20 wee~s aestAtlon, total nu~bP.r orior tn currP~t orPqnancv 52r;O •••• VAR ~90 ]QO Prean~n~lP.s, ~ultlple, tot!l number orlor to current oreanancv '52'5l •••• VAR 2 391 ]Qt sttllhirths: deat~s at 20 •ee~s ~Pstatlon or areater: fetal ~eat~ orfor to current orea~anev !§252 •••• YAR 2 19? ]Ql oeatns: nP.onatal an~: stlllhlrths, total nu•ber prior to current nreanancv 52Sl •••• YAR 394 JQS Preanancv, last orlor: aest~tfon £wks) H H > •N olio> @ I IV
COLIII:•IOoa-& ,.., REPRODUCTIVE HISTORY (lra~~n~i...,.r) """.". 'DATI: (llo.D•·Yr) I RECORD PREGNANCIES IN CHRONOLOGICAL ORDER PREGNANCY ORDER: I 2 3 s I. DATE OF TERMINATION OF PREGNANCY 2. GESTATION ('Wul&~) 3. LIVEBORN (Yu or No) 4.. D & C AFTER MISCARRIAGE s. SEX (M or F) 6. NAME OF CHILD " COMPLICATIONS OF 7. PREGNANCY 8. INDUCED LABOR (Yu or No) 9. DURATION OF LABOR (Hour~) Vaginal TYPE c.... 10. OF .,.,.,. DELIVERY BrHch ~=~~·- II. BIRTH WEIGHT (U.~.- Os.) 12. PLACE OF BIRTH RI!CORD CITY AND NAME Of HOSPITAL IN SPACE BELOW 13• ~r~~~~LITIES 14. NA~ OF FATHER IS. RACE OF FATHER DATE OF DEATH 16. OF CHILD 17. PLACE OF DEATH 18. CAUSE OF DI!ATH - INFORMANT ('Wbne ~owe• 19. i~ b~pital -.cord~. iMicat• by •n• J 12. PLACE OF BIRTH IR•corti Citv arui Na- o/ Host>ital) I. 2. 3. "· 5. IF MORE THAN 5 PREGNANCIES, USE ANOTHER FORM. C.II.......... R..... Pwtn.... Re................ HINDI, NIH .......... 14,MII. (DI-2) (Je•. 1-41) II.A.25 OB-2 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 and 38: -· IID'~7-- '·"'-- ':!e- ~ l·-~
Page 39 and 40: OB-1: OBSTETRICAL· ADMINISTRATIVE
Page 41 and 42: Par. 3 10 - Religion. Record as Cat
Page 43 and 44: OB-2 Reproductive History Form OB-2
Page 45: Reproduced at the National Archives
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 97 and 98:
Reproduced at the National Archives
Page 99 and 100:
DEFINITION OF CODES RECENT MEDICAL
Page 101 and 102:
DEl!'INITION OF CODES (Continued) F
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DEFINITION OF CODES (Continued) FOR
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ILL..'1ESS OR DISABILITY CODES (Con
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Page 111 and 112:
RECENT MEDICAL HISTORY (Con 1 t) OB
Page 113 and 114:
OB-6 Past Medical History Form OB-6
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Page 117 and 118:
z PAST MEDICAL HISTORY (Interviewer
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Page 121 and 122:
DEF'll'UTION OF CODES PAST MEDICAL
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DEF'INli'ION OF CODES (Continued) F
Page 125 and 126:
DEFINITION OF CODES (Continued) u.
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DEFINITION OF CODES (Continued) FOO
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Page 131 and 132:
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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Page 161 and 162:
Page 163 and 164:
DEFINITION OF CODES (Continued) FIE
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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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Page 173 and 174:
Page 175 and 176:
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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:
Page 185 and 186:
~~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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Page 195 and 196:
ZEFT1ITTIO:i OF CODES (Con"'c:..!!U
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Page 199 and 200:
Page 201 and 202:
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
Page 213 and 214:
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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Page 221 and 222:
-· eoL"-aooa-..a 08-42 PAST MEDICA
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Page 225 and 226:
Page 227 and 228:
Page 229 and 230:
Instruction Manual for Obstetric Fo
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OB-43 Initial Prenatal Examination
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Page 235 and 236:
Page 237 and 238:
COL ..-3008-41 UIIYe 10.U) 1. PATIE
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Page 241 and 242:
DEFINITION OF CODES miTIAL PRENATAL
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Page 245 and 246:
Page 247 and 248:
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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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
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Page 277 and 278:
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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Page 289 and 290:
: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
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OB-45 Laboratory Record Form OB-45
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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
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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
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DEFTIUTION OF CODES (continued) FIE
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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
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CO~A·3C03·11 lltEV. '7·58 I. PAT
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RECORD OF CURRENT PREGNANCY (For Fo
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,... RECORD OF CURRENT PREGNANCY IN
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OB-46 Physician•s Clinic Record,
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COLR-1001-4e 4-a I. PATIENT IDENTII
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Instruction :\l:J.nual for Obstetri
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OB-12 Summary of Hospitalization fo
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SUMMARY OF HOSPITALIZATION FOR ANY
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SUMMARY OF HOSPITALIZATION FOR ANY
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':.::-•••suMMARY OF HOSPITALI
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OB-47 Summary of Antepartum Hospita
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· COLIII-IOOa..7 (CHANGIED 2-8a)
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OB-15 Drugs in Pregnancy Form OB-15
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PH S.300S.18 ..... PATIENT IDENTIFI
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.... PMS•3003•18 PATIENT IDENTI
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PHI·IOOI .. 1B P"TIENT IOENTIFIC"T
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PATI~NT IDENTIFICATION OB-15 DRUGS
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..... PHS .. 3003 ... 11 PATII!NT I
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DEFINITION OF CODES DRUGS lN PREGN
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Drugs in Pregnancy (08-15) Blank 0
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Drugs in Pregnancy (cont.} 2128 Par
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Orugs in Pregnancy (cont.) 4256 Hyo
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. Drugs in Pregnancy (cont.) 7154 S
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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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