Prenatal Record - National Archives and Records Administration

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Reproduced at the National Archives H H > • ..... 0\ @ I U1 ForM Ite~ Nu~bers Ji~~ed to Oata Ite~s on ~tl-5, Recent ~edfcal ~fstorv ITEM DATA ON TrF:" CARD FORM In NIIM FROio! TO DAfA TTFM NAMF. to 121 ••• os-~ noc; H 43 Illness or ~lsabllltv, re~uirlno conflne~ent: ohvstclan consulted or hosoltallze~ to 327 ••• ns-5 13o"i 54 54 Illness or dlsablllty, re~utrtna cont1ne~ent: ohvslclan consulted or hosoitallze1 to 333 ••• na-5 1305 6"i 65 Illness or ~isabilttv, requtrfna confinement: ohvslclan consulted or hosottalize1 t 0 lts ••• na-5 130'5 32 32 Illness or ~i~abllitv, re~ulrtna confinement: ohvsieian consulted or hosoltalize~ 12 348 ••• oa-5 2305 36 37 Illness or dlsahlllty, non conflnJn~, date 12 347 •••ns-5 210'5 34 35 Illness or dtsabllttv, non contlnlna, date 12 J4~ ••• ns-5 210~ 31' 19 Illness or ~tsahlllty, non eonflntna, date 12 151 ...!'JB-5 230'5 41 42 Illne5S or dtsabllttv, non contlnlna, tvoe 12 12 12 t1 11 11 13 u 13 346 ...'l8•5 141 •••no-s 1so ••• oo-s 2~0"i 2J05 2lO"i 32 23 40 33 24 40 Illne5s Illness Illness or or or ~tsablltty, non ~lsabllitv, non dtsablltty, non disability, non ~1sab111ty, non ~isab111ty, non ~tsabllttv, non dlsabllttv, non disahlltty, non conflntna, eonttnlnq, conflnlna: onset onset onset (day) (mo) Cyr) tyoe type physician consulted 353 ••• 08-5 230'5 4'5 46 Illness or conflnfna, date onset (day) 343 ••• na-s 2305 27 78 Illness or contlnJna, date onset (day) 1s2 ••• na-s 2J05 44 Illness or conffnfna, date onset (Mo) H2 ••• IJB-~ 230'5 25 ·~ ?b Illness or conftnlna, date onset C•o) 354 ••• ns-5 noo; 47 48 Illness or eont1ntna, d8te onset (yr) 144 •••'lB-5 2JO"i 2Q 10 Jllne5s or conftntna, d8te onset (yr) t4 355 ••• 08-5 2~0"i 4q 49 Illness or ~isablllty, non conttntn~; physician consulted 1 4 H'i ••• ns-s 23o"i 31 31 Illness or dtsah111tv, non conttnlna; p~vsician consulted 16 356 ••• ns-s nos; 50 50 I~muntzatton, pre/oost LMP, precedlnq 17 months 1 7 357 ••• ns-5 210"i 51 ~1 Antlolotic fn1ertton, oretoost f,~P, orecedin~ i2 months tl:l JSP ••• ns-5 noc; 52 ~2 Antfbfotlrs, other, pre/onst r,MP, orece~in~ 12 months 20 3&0 •••na-s noc; 54 "i4 Jn1Pctton, un~nn•n, ore/onst LMP, orecedln~ 12 ~ont~s 21 36t ••• na-s 230"i 5'5 "iS SlePofn~ ollls, ore/oost r.~P, orecedina 12 months ?2 1&2 ••• ns-5 230"i 56 '5& Tranquilizers, or~/oost LMP, orecedina t2 nonths 23 163 ••• os-5 230'5 51 11)7 otet or •nep" ollls, orP/o,st LMP, orecedlna 12 months 24 364 ••• os-s 2305 5R ~8 Antfhlstamines, pre/oost L~P, orece~lng 12 months 75 16"i ••• na-5 23oo; 5Q ~9 Jnsultn, ore/oost LMP, rreceilno 12 ~nnths ?6 3&6 ••• '18-5 210'5 6fl 60 Thvrotrl or anti-thyroid, ore/oost LMP, Drecedlna t2 nonths '11 367 ••• 08-5 230"i bt 61 Cortisone, pre/oost LMP, orecPdfna 12 months '18 36fl ••• oa-5 21oo; &2 62 Hormones, other, nre/oost LMP, orecedlno 12 months 79 l5Q ••• oa-5 2305 51 "i3 tn1ectJon, other, orelpnst J.MP, preee~lna 12 months 10 J&Q ••• no-5 230"i f>J 63 L~xatfvPs, orP/oost LMP, orPcedtna 12 months lt 370 ••• na-5 210'5 &4 64 Headache ollls, oo•ders, ore/oost LMP, orecedtna 12 ~onths 32 111 ••• os-5 230'5 &"i 65 MedicAtion or injection, other, oreloost LMP, orecedina 12 months
DEFINITION OF CODES RECENT MEDICAL HISTORY FORM OB-5 CARD 1305 CARD COWMN 1. Card Number Code: 1 2. Form Number Code: 305 3· Revision Number * Code: 0 - Form Dated: 1 - Form Dated: 1/59 Rev. 11/59 1 2-4 5 4. NINDB Number Nine-digit number for Patient Identification. Code: As given 5· Date Form Completed Item 5 Six-digit code for month (eels. 15-16), day (eels. 17-18) and year (eels. 19-20) Code: As given 99 - Month, day and/or year unknown 6-14 15-20 6. Number of Illnesses or Disabilities Requiring Confinement to Bed Rem b Code: 0 - None 1-7 - As reported 8 - 8 or more reported .9 -Unknown 1· IliL1mSS
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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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Page 47 and 48: COLIII:•IOoa-& ,.., REPRODUCTIVE
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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: Reproduced at the National Archives
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
Page 145 and 146: DEl''ll'IITION OF C:JDES ( Conti:::
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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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~~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
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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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