APGAR

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Republic of the Philippines

Western Mindanao State University


COLLEGE OF MEDICINE
Zamboanga City, Philippines

Patient’s Name:__________________________________________ Date:____________________________

Mother’s Name:__________________________________________ Time of Delivery:___________________

Manner of delivery:

( )NSD ( )CS ( )Others ______________________________ AOG:

OSPE

APGAR SCORE: ______1 Minute ______5 Minutes _______10 Minutes

SIGN
0 1 2 1 minute 5 minutes 10 minutes

Heart Rate Absent Less Than 100 Over 100

Respiratory
Absent Slow, Irregular Good Cry
Effort

Muscle Tone Limp Some Flexion Active Motion

Reflex
No Response Grimace Cry
Irritability

Body Pink,
Color Pale Extremities All Pink
Blue

TOTAL SCORE

___________________________ ___________________________
Facilitator Student

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