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Original site: www.cdc.gov/nchs/nvss/facility-worksheets-guide/15.htm | RestoredCDC.org is an independent project, not affiliated with CDC or any federal entity. Visit CDC.gov for free official information. Due to archival on January 6, 2025, recent outbreak data is unavailable. Videos are not restored. Access data.restoredcdc.org for restored data. Use of this site implies acceptance of this disclaimer.[More]About Us Report Bug Compare ContentSkip directly to site content Skip directly to searchEspañol | Other LanguagesHere's how you knowAn official website of the United States government Here's how you knowNational Center for Health StatisticsNational Center for Health StatisticsCenters for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People National Center for Health StatisticsSearchSearch Menu Navigation Menu× Search NCHSSearch NCHS All CDCSubmitNational Center for Health Statistics* Facility Information+ BACKFacility Information+ Facility name+ Facility ID+ City, town, or location of birth+ County of birth+ Place where birth occurred (Birthplace)+ National Center for Health Statistics Home* Prenatal Care and Pregnancy History+ BACKPrenatal Care and Pregnancy History+ Date of the first prenatal care visit+ Total number of prenatal care visits for this pregnancy+ Date last normal menses began+ Number of previous live births now living+ Number of previous live births now dead+ Date of last live birth+ Number of other pregnancy outcomes+ Date of last other pregnancy outcome+ Risk factors in this pregnancy+ Infections present and/or treated during this pregnancy+ Obstetric procedures+ National Center for Health Statistics Home* Labor and Delivery+ BACKLabor and Delivery+ Date of birth+ Time of birth+ Certifier’s name and title+ Date certified+ Principle source of payment+ Infant’s medical record number+ Was the mother transferred to this facility for maternal medical or fetal indications for delivery?+ Attendant’s name, title, and ID+ Mother’s weight at delivery+ Characteristics of labor and delivery+ Method of delivery+ Maternal morbidity (maternal transfusion)+ National Center for Health Statistics Home* Newborn Information+ BACKNewborn Information+ Birthweight or weight of fetus+ Obstetric estimate of gestation at delivery+ Sex of child+ Apgar score+ Plurality+ If not a single birth, order born in the delivery+ If not a single birth, number of infants in the delivery born alive+ Abnormal conditions of the newborn+ Congenital anomalies of the newborn+ Was the infant transferred within 24 hours of delivery?+ Is the infant living at the time of the report?+ Is the infant being breastfed at discharge?+ Method of disposition+ National Center for Health Statistics Home* National Center for Health Statistics HomeNational Center for Health StatisticsNational Center for Health Statistics Home15. Infections present and/or treated during this pregnancyInfections present and/or treated during this pregnancyRelated PagesCategory: Prenatal Care and Pregnancy HistoryBC # 4215. Infections present …Infections present at the time of the pregnancy diagnosis or a confirmed diagnosis during the pregnancy with or without documentation of treatment.DefinitionsDocumentation of treatment during this pregnancy is adequate if a definitive diagnosis is not present in the available record.Check all boxes that apply. The mother may have more than one infection.InstructionsIf the mother has none of the risk factors, check “none of the above.”Sources See below“+” indicates that the test for the infection was positive and the woman has the infection.Keywords and Abbreviations “–” indicates that the test was negative, and the woman does not have the infection.Look for: treatment or Rx for specific infection.GonorrheaDefinitions A positive test or culture for Neisseria gonorrhoeae.Instructions1st Prenatal record under –* Infection history* Sexually transmitted diseases* Problem list* Complications this pregnancy* Factors this pregnancy* Medical history2nd Labor and delivery nursing admission triage form under – CommentsSources3rd Admission history and physical (H&P) under –* Current pregnancy history* Medical history* Problem list/findings4th Delivery record under –* Maternal OB/labor summary* Labor and delivery admission historyGCGonorrhealKeywords and Abbreviations GonoccocalTreatment or Rx for GonoccheaNAAT–Nucleic amplification testsSyphilis (also called lues)Definitions A positive test for Treponema pallidum.Instructions1st Prenatal record under –* Infection history* Sexually transmitted diseases* Problem list* Complications this pregnancy* Factors this pregnancy* Medical history2nd Labor and delivery nursing admission triage form under – CommentsSources3rd Admission history and physical (H&P) under –* Current pregnancy history* Medical history* Problem list/findings4th Delivery record under –* Maternal OB/labor summary* Labor and delivery admission historyTP-PA–T. pallidum particle agglutinationSTS–Serologic test for syphilisRPR–Rapid plasma regainKeywords and Abbreviations VDRL–Venereal disease research laboratoriesFTA-AS–Fluorescent antibody testLuesTreatment or Rx for syphilis or luesChlamydiaDefinitions A positive test for Chlamydia trachomatis.Instructions1st Prenatal record under –* Infection history* Sexually transmitted diseases* Problem list* Complications this pregnancy* Factors this pregnancy* Medical history2nd Labor and delivery nursing admission triage form under – CommentsSources3rd Admission history and physical (H&P) under –* Current pregnancy history* Medical history* Problem list/findings4th Delivery record under –* Maternal OB/labor summary* Labor and delivery admission historyKeywords and Abbreviations Treatment or Rx for chlamydiaHepatitis B (HBV, serum hepatitis)Definitions A positive test for the hepatitis BInstructions1st Prenatal record under –* Infection history* Sexually transmitted diseases* Problem list* Complications this pregnancy* Factors this pregnancy* Medical history2nd Labor and delivery nursing admission triage form under – CommentsSources3rd Admission history and physical (H&P) under –* Current pregnancy history* Medical history* Problem list/findings4th Delivery record under –* Maternal OB/labor summary* Labor and delivery admission historyHep BKeywords and Abbreviations HBVTreatment or Rx for hepatitis BHepatitis C (non A or non B hepatitis [HCV])Definitions A positive test for the hepatitis C virusInstructions1st Prenatal record under –* Infection history* Sexually transmitted diseases* Problem list* Complications this pregnancy* Factors this pregnancy* Medical history2nd Labor and delivery nursing admission triage form under – CommentsSources3rd Admission history and physical (H&P) under –* Current pregnancy history* Medical history* Problem list/findings4th Delivery record under –* Maternal OB/labor summary* Labor and delivery admission historyHep CKeywords and Abbreviations HCVTreatment or Rx for hepatitis CChoose a Different ItemThis filtering area contains options for sorting data dynamically for easy discovery. Filtering options include search by text, dropdowns for filtering based on various fields, and various sorting.Search1 content filters available.1 of 1 content filters. Filter by CategoriesPrenatal Care and Pregnancy HistoryFilter by Categories Facility Information Labor and Delivery Newborn Information Prenatal Care and Pregnancy HistorySubmit ClearFound 11 items out of 41 total items.Search resultsSortTitle Ascending Title Descending6. Date of the first prenatal care visitThe date a physician or other health care professional first examined or counseled the pregnancy woman for the pregnancy.Categories: Prenatal Care and Pregnancy History7. Total number of prenatal care visits for this pregnancyThe total number of visits recorded in the record.Categories: Prenatal Care and Pregnancy History8. Date last normal menses beganThe date the mother’s last normal menstrual period began.Categories: Prenatal Care and Pregnancy History9. Number of previous live births now livingThe total number of previous live-born infants now living.Categories: Prenatal Care and Pregnancy History10. Number of previous live births now deadThe total number of previous live-born infants now dead.Categories: Prenatal Care and Pregnancy History11. Date of last live birthThe date of birth of the last live-born infant.Categories: Prenatal Care and Pregnancy History12. Number of other pregnancy outcomesTotal number of other pregnancy outcomes that did not result in a live birth.Categories: Prenatal Care and Pregnancy History13. Date of last other pregnancy outcomeThe date that the last pregnancy that did not result in a live birth ended.Categories: Prenatal Care and Pregnancy History14. Risk factors in this pregnancyRisk factors of the mother during this pregnancy (e.g., diabetes, prepregnancy diabetes, gestational diabetes, hypertension, prepregnancy hypertension, gestational hypertension, eclampsia, previous preterm births, pregnancy resulted from infertility treatment, fertility-enhancing drugs, assisted reproductive technology, mother had a previous cesarean delivery).Categories: Prenatal Care and Pregnancy History15. Infections present and/or treated during this pregnancyInfections present at the time of the pregnancy diagnosis or a confirmed diagnosis during the pregnancy with or without documentation of treatment (e.g., Gonorrhea, Syphilis, Chlamydia, Hepatitis B, Hepatitis C).Categories: Prenatal Care and Pregnancy History1 of 2* Previous* 1* 2* NextLast Reviewed: August 5, 2019Source: National Center for Health Statistics* Syndicatehome Guidebook Home* Facility Information plus icon+ Facility name+ Facility ID+ City, town, or location of birth+ County of birth+ Place where birth occurred (Birthplace)* Prenatal Care and Pregnancy History plus icon+ Date of the first prenatal care visit+ Total number of prenatal care visits for this pregnancy+ Date last normal menses began+ Number of previous live births now living+ Number of previous live births now dead+ Date of last live birth+ Number of other pregnancy outcomes+ Date of last other pregnancy outcome+ Risk factors in this pregnancy+ Infections present and/or treated during this pregnancy+ Obstetric procedures* Labor and Delivery plus icon+ Date of birth+ Time of birth+ Certifier’s name and title+ Date certified+ Principle source of payment+ Infant’s medical record number+ Was the mother transferred to this facility for maternal medical or fetal indications for delivery?+ Attendant’s name, title, and ID+ Mother’s weight at delivery+ Characteristics of labor and delivery+ Method of delivery+ Maternal morbidity (maternal transfusion)* Newborn Information plus icon+ Birthweight or weight of fetus+ Obstetric estimate of gestation at delivery+ Sex of child+ Apgar score+ Plurality+ If not a single birth, order born in the delivery+ If not a single birth, number of infants in the delivery born alive+ Abnormal conditions of the newborn+ Congenital anomalies of the newborn+ Was the infant transferred within 24 hours of delivery?+ Is the infant living at the time of the report?+ Is the infant being breastfed at discharge?+ Method of disposition* About CDC* Contact Us* 800-232-4636Facebook Twitter Instagram LinkedIn Youtube Pinterest SnapchatFacebook Twitter Instagram LinkedIn Youtube Pinterest Snapchat RSS* CONTACT CDCContact UsCall 800-232-4636Email Us* ABOUT CDC+ About CDC+ Jobs+ Funding* POLICIES+ Accessibility+ External Links+ Privacy+ Policies+ Web Policies+ No Fear Act+ FOIA+ OIG+ No Fear Act+ Nondiscrimination+ Vulnerability Disclosure Policy+ CDC Archive+ Public Health Publications+ HHS.gov+ USA.gov* CONNECT WITH US+ Youtube+ Snapchat* LANGUAGES+ Español+ 繁體中文+ Tiếng Việt+ 한국어+ Tagalog+ Русский+ العربية+ Kreyòl Ayisyen+ Français+ Polski+ Português+ Italiano+ Deutsch+ 日本語+ فارسی+ English* U.S. Department of Health & Human Services* Accessibility* External Links* Privacy* Policies* Web Policies* FOIA* OIG* No Fear Act* FOIA* Nondiscrimination* OIG* Vulnerability Disclosure Policy* CDC Archive* Public Health Publications* HHS.gov* USA.govContent Credential×This image was edited or created using GenAI (generative artificial intelligence).Our experts review all images in an effort to ensure accuracy and quality before use.Learn more about CDC's usage of GenAI.
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