Republic of the Philippines

Province of Batangas
Municipality of Bauan
BAUAN RHU-II BIRTHING FACILITY
APLAYA, BAUAN, BATANGAS
Tel No.: 980-9147

HOSPITAL NO.:
FAMILY NAME: FIRST NAME: MIDDLE NAME: ATTENDING PHYSICIAN: ROOM/BED NO.: FILE NO.:

APGAR SCORING
Gestational age _________________ weeks

APGAR Signs 0 1 2
1 minute 5 minutes
Appearance Blue or Pale Acrocyanotic
Completely Pink
(Skin Color)
Pulse Absent < 100 minute
> 100 minute
(Heart Rate)
Grimace No Response Grimace Cry or Active
(Reflex Irritability) Withdrawal
Activity Limp Some Flexion
Active Motion
(Muscle Tone)
Respiration Absent Weak Cry;
Good Crying
(Breathing Rate) Hypoventilation
Total

NEWBORN MATURITY RATING and CLASSIFICATION

Gestation by Dates
Weeks _________
Birth Date ______ Hour am/pm