Newborn APGAR Score Assessment Form
Document the APGAR assessment for a newborn accurately and efficiently.
Newborn First Name or Identifier
*
Date and Time of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Assessor Name or Role
*
Heart Rate (Pulse) Score
*
0 - Absent
1 - Below 100 bpm
2 - 100 bpm or above
Respiratory Effort Score
*
0 - Absent
1 - Slow or irregular
2 - Good, crying
Muscle Tone Score
*
0 - Limp
1 - Some flexion
2 - Active motion
Reflex Irritability Score
*
0 - No response
1 - Grimace
2 - Cough, sneeze, cry
Color Score
*
0 - Blue or pale
1 - Body pink, extremities blue
2 - Completely pink
Total APGAR Score
Notes / Remarks
Submit Assessment
Should be Empty: