Prenatal Record - National Archives and Records Administration

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Reproduced at the National Archives 1-1 1-1 >• -..J ~ @ I tTl Data Ite~s Refere~cln~ For~ ns-s, Recent Medtcal Htstorv OAf A lTF::fl4 ITE14 Jllf CARO YO FJR14 NUM FROM TO OA U IrF.M NAMF. 342 ••• oR-"i 13 2305 25 ?6 Illness or rttsabilltv, non conft~tnq, date onset C•o> 343 ••• oR-"i tJ 230'5 27 28 Illness or rtisah111ty, non contt~tna, date onset (day) 344 ••• oR-"' 11 2305 29 10 Illness or rtlsabllity, non conft~fna, date onset (yr> 345. • .OR•5 14 2305 )t Jt Illness or rt1sab111ty, non contintna; ohysician consulted 346 ••• 01'1•5 12 2305 32 33 Illness 347 ••• 01'\-~ 12 230'5 34 15 Illness or or rtlsahllitv, ~isahillty, non non conftntng, conftnfna, date tyoe onset (mo) 34B ••• OR·'i 12 2305 ]fi 37 Illness or rttsabllltv, non conttntna, d~te onset (day) 349 ••• oR-" 12 2]0'5 lA J9 Illness or rtlsablltty, non conftntna, date onset (yr) )SO. • .OA•5 12 2305 40 40 Illness or rtlsabllltv, non conttnlna; ohvslclan consulted 3'5l ••• DR•"i 12 230'5 41 42 Illness or dlsabllltv, non eontintng, tvoe )'§2••• DA•5 11 2305 41 44 Illness 3'5l ••• DA•tll 11 2105 4"i 46 Illness or or disability, disahilitv, non non conttnfna, contfntna, date datP onset onset (dey) C•o> 3'54 ••• DR•5 11 230'5 47 48 Illness or ~tsablllty, non conftntna, date onset Cyr) 3'55. • .OR•"i 14 2305 4~ 49 Illness or rttsahlllty, non conflntn~l phystcien consulted 3'§6 ••• DR•"i 16 230"i so 50 I~~untzatfon, ore/oost L~P. preceding t2 months 3'57 ••• DR•S 1"'B ••• DR·"i 3'59 ••• oR-"i 3~o ••• oR-"i 16l ••• DR•5 17 tll 29 20 21 2305 2305 210'5 '230S 2305 51 52 53 54 55 51 Anttbtotir fn1ectfon, pre/oost L~P, precedina 12 •onths ~2 Antfbtotlcs, ~ther, ore/oost L~P, orecedlnq 12 months 53 In1ection, other, ore/post L~P, orecedlnq 12 Montha ~4 In1ection, un~nown, ore/oost f,MP, orece~lng 12 •onths ~5 Sle~otno ollls, ore/oost r.~P, orecedlna 12 •onths lfi2 ••• DR•5 22 2305 56 56 Tranquilizers, ore/oost LMP, orecedln~ 12 •onths 363 ••• o~'~-5 21 230'5 57 57 Otet or "oep• pills, ore/o,st LMP, precedina 12 •onths 364 ••• DR•'5 24 230"i SA 58 Antihistamines, ore/oost r.~P. orecedtng 12 Months 36S ••• DR•"i 21\ 230'5 5~ '59 Jnsulfn, ~re/oost LMP, orecedtna 12 months Jfo6 ••• oR-"i 2" HO"i 60 ~o Thyroid or anti•thvrotd, ore/nost LMP, orecedfna 12 months 367 ••• o~'~-5 21 230"i 61 61 Cortisone, nre/oost LMP, orecP.1fnq 12 months 36B ••• DR•5 2P 230'5 62 62 HorMones, other, ore/post LMP, orecedlna 12 months )fo9••• DR•'5 )70••• DR•"i 371 ••• DR•5 30 31 37. HO"i 2JO"i Hoc; 61 64 6"i 63 64 65 Laxat1ves, nre/oost LMP, He~dache oills, oowders, Medication or fn1ect1on, orecedfno 12 months ore/nost LMP, orecedlnQ 12 aonths other, ore/oost LMP, orecertinq 12 months 372 ••• 01'1-"\ 2JO"\ 6fi 66 I•muntzatton, ves/no, orecedtnq 12 months 37l ••• OR•"i 230"i 67 67 Antfbfotics, ves/no, orece1tno 12 months 374 ••• oR-5 2105 6A 68 In1ection, ves/no, other, orece~ina 12 months )75••• 01'\•5 l76 ••• oR-I\ 377 ••• oA-"i )78 ••• 0"--"i 379 ••• 0~'~•" lPO ••• OR•"i )Rl ••• OR•"i 3A2 ••• DR-~ )R)••• U"~•"i )R4••• 0R·5 230"i 230"i 230"i 2305 2]05 230'5 2J05 2JO'l 2305 2105 69 70 71 77. 73 74 '"' 76 77 7A 69 70 71 72 73 74 75 76 77 78 Injection, ves/no, unknown, orece~ing 12 Ant1blot.ics, ves/no, other, orecertinq 1? months months L~xattves, ves/no, orecedl~a 12 months Sleeotna pills, ves/~o. orece11n~ 12 months Tranquilizers, yes/no, nrecedfn~ 12 months Dtet or "nen" otlls, yes/n,, nrecedino 12 months Headache nills, yes/no, oowrters, orecedlna Nose droos; inhalers, yes/no, orece11nq 12 Antthtstamlnes, yes/no, orecedinq 12 Medlc~t1on, ves/no, other, nrecedfno months 12 months 12 months months
Reproduced at the National Archives nata Ite•s R~fer~nclng Form ns-5, Recent ~~dfc~l H1storv DITA trF'!t ITEM ON CARO TO FJIHII NIIM FROM TO DATA TTF.M NAME JAS ••••••• 230"i 7q 110 Blanlt 520& •••• YAP 6 315 315 Illness cnnfinin~, orecedf,~ 12 ~onths, totBl number H H ).. . ....,J w @ I 01
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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
Page 43 and 44: OB-2 Reproductive History Form OB-2
Page 45 and 46: Reproduced at the National Archives
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: Reproduced at the National Archives
Page 99 and 100: DEFINITION OF CODES RECENT MEDICAL
Page 101 and 102: DEl!'INITION OF CODES (Continued) F
Page 107 and 108: ILL..'1ESS OR DISABILITY CODES (Con
Page 111 and 112: RECENT MEDICAL HISTORY (Con 1 t) OB
Page 113 and 114: OB-6 Past Medical History Form OB-6
Page 117 and 118: z PAST MEDICAL HISTORY (Interviewer
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 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 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
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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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DEFINITION OF CODES (Continued) FOR
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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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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 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
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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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Page 295 and 296:
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
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DEFINITION OF CODES (continuted) FI
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DEFTIHTION OF CODES (continued) FIE
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DEFTIUTION OF CODES (continued) FIE
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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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