Newborn Medical History Template
Infant Information
Full Name
Date of Birth
Gender
Male
Female
Other
Birth Weight (g)
Birth Length (cm)
Gestational Age (weeks)
Maternal Information
Mother's Name
Mother's Age
Maternal Medical History
Prenatal Care Details
Pregnancy & Delivery
Type of Delivery
Vaginal
Cesarean Section
Assisted
Complications During Pregnancy
Complications During Delivery
Newborn Assessment
Apgar Scores (1 min, 5 min)
Physical Findings/Examination
Screenings Performed
Initial Interventions/Treatments
Family Medical History
Notes / Additional Information