Newborn Assessment Form

Purpose: This form is used by medical professionals to assess the health, appearance, and vital reflexes of a newborn immediately after birth. It helps document key observations necessary for determining the baby's status and need for further medical attention.

General Information

• Date of Birth: {dateOfBirth}
• Time of Birth: {timeOfBirth}
• Place of Birth: {placeOfBirth}
• Infant Name: {infantName}
• Gender: {gender}
• Mother's Name: {motherName}
• Gestational Age: {gestationalAge} weeks
• Delivery Type: {deliveryType}

Initial Observations

APGAR Score

The APGAR score is assessed at 1 minute and 5 minutes after birth based on five criteria.

Total 1 Minute Score: {totalOneMinScore}

Total 5 Minute Score: {totalFiveMinScore}

Reflexes & Activity

• Moro Reflex: {moroReflex}
• Grasp Reflex: {graspReflex}
• Rooting Reflex: {rootingReflex}
• Suck Reflex: {suckReflex}
• Tone and Movement: {toneAndMovement}

{#abnormalFindings}

Abnormal Findings

• {findingDescription}

{/abnormalFindings}

{^abnormalFindings}

No abnormal findings reported.

{/abnormalFindings}

Feeding Status

• Initial Feeding: {initialFeeding}
• Feeding Method: {feedingMethod}

Additional Notes

{additionalNotes}

Completed by: {completedBy}

Date: {completionDate}