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PROFESSIONAL REGULATION COMMISIONPRC FORM No. 106(Revised October 2010)
ManilaBOARD OF MIDWIFERYRecord of Actual Deliveries HandledPlease Check: Graduate Midwife Registered Nurse
Name of Applicant: MICHAEL ANGELO B. SEA School: MABINI COLLEGES, DAET CAMARINES NORTE
Name and Address of PatientCase No.Complete Diagnosis(Gravida_Para_)Date & Time PerformedFull Name, Address of Facility & Contact NumberCheck if Home Del.Supervised by:
Printed Name & Contact No.Position/ DesignationSignatureLicense No./Expiration Date
1.BATALAO,CATHERINECANAPAUAN, LABO C.N.270304G1P0 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM6-24-131:32 AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
2.MARMOLEJO,REINALABMIG PARACALE C.N.260941G1P0 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM6-15-1311:35AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
3.ACLANO,ERLINIGANG PARACALE C.N.220848G1P0 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM7-6-135:35AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
4.TABUZO,JESSICAMALANGCAO BASUD LABO C.N.27055G1P0 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM6-30-13
LABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
5.BANING VANESSAFISHPORT PARACALE C.N.198041G1P0 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM7-31-137:35AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
6.FRANCISCO,HAZELTAWIG LABO C.N.280956G1P0 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM8-14-139:15AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
7.PAJARILLO,CHONAMASALONG LABO C.N.290142G1P0 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM8-20-1312:22PMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
8.FINALLA,MARICELTUGOS,PARACALE C.N.281742G1P0 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM9-11-1310:49AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
9.JALIMAO,MARIEP.MUNT PARACALE281846G1P0 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM9-13-134:35AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
10.EREPALA,JOCELYNMACOGON, LABO C.N.281031G1P0 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM10-28-135:45AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
(Continued at the Back)
Name and Address of PatientCase No.Complete Diagnosis(Gravida_Para_)Date & Time PerformedFull Name, Address of Facility & Contact NumberCheck if Home Del.Supervised by:
Printed Name & Contact No.Position/ DesignationSignatureLicense No./Expiration Date
11.BRAGA ,LIZATUGOS PARACALE C.N.260781G3P2 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM6-10-133:45PMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
12.JINQUE,EDLYNGUMAMELA LABO C.N.280093G2P1 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM7-20-1310:20PMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
13.EVALDERASA,SHIELANICO PARACALE C.N.260485G3P2 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM6-5-132:03AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
14.ESTABYA,ANALYNTALUSAN PARACALE C.N.280661G2P1 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM8-15-134:35PMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
15.PALMERO,RONALIEMALAGNIT PARACALE C.N.281223G2P1 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM8-28-134:45AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
16.TOLINTINO,NINADAGUIT, LABO C.N283423G5P4 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM10-23-134:15AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
17.GAPOY,ALMABAAY LABO C.N.283336G2P1 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM10-19-134:05AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
18.ALAPAA,BELMELASTA.SONA SUR JOSE PANGANIBAN C.N.270056G4P3 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM01-16-1312:24PMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
19.MAGIMPA,NORJEANMASALONG LABO C.N.281980G3P2 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM9-17-1310:30AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
20.NUDO,NERISSASTA. ROSA NORTE JOSE PANGANIBAN C.N.281394G2P1 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM9-20-1311:18PMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
Note:1) For graduate midwives: Supervision must be by qualified faculty/clinical instructor.CERTIFIED CORRECT:
Signature: ______________________ Date: ____________Printed Name: YOLANDA C.RUSTIA RN.RM,MAN oDesignation: PRINCIPAL OF MIDWIFERY oLicense Number:0175887/0112842 Expiry Date: SEPT. 25 2016SUBSCRIBED AND SWORN To before me this ____________________ at _____________________Affiant exhibiting to me his/her Residence Certificate No. 25927910 issued at DAET CAMARINES NORTE on JANUARY 3 2014.
________________________________________________________ADMINISTERING OFFICER OR NOTARY CLUBAffixDocumentary Stamp(to be posted on the last page)
PROFESSIONAL REGULATION COMMISIONPRC FORM No. 107(Revised October 2010)
ManilaBOARD OF MIDWIFERYRecord of Actual Suturing of Perineal LacerationPlease Check: Graduate Midwife Registered Nurse
Name of Applicant: MICHAEL ANGELO B. SEA School: MABINI COLLEGES, DAET CAMARINES NORTE
Name and Address of PatientCase No.Complete Diagnosis(Gravida_Para_)Date & Time PerformedFull Name, Address of Facility & Contact NumberCheck if Home Del.Supervised by:
Printed Name & Contact No.Position/ DesignationSignatureLicense No./Expiration Date
5.BANING VANESSAFISHPORT PARACALE C.N.198041G1P0 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM7-31-137:35AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
6.FRANCISCO,HAZELTAWIG LABO C.N.280956G1P0 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM8-14-139:15AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
7.PAJARILLO,CHONAMASALONG LABO C.N.290142G1P0 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM8-20-1312:22PMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
8.FINALLA,MARICELTUGOS,PARACALE C.N.281742G1P0 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM9-11-1310:49AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
9.JALIMAO,MARIEP.MUNT PARACALE281846G1P0 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM9-13-134:35AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
10.EREPALA,JOCELYNMACOGON, LABO C.N.281031G1P0 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM10-28-135:45AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
Note:1) For graduate midwives: Supervision must be by qualified faculty/clinical instructor.2) Registered Midwives/Clinical Instructors who supervise student midwives and affix their signature in this Form must present Certificate of Training on Suturing of Perineal lacerations to the Board pursuant to Board Resolutions No. 100, Series of 1993, dated December 1,1993
(See back page)
PROFESSIONAL REGULATION COMMISIONPRC FORM No. 107-A(Revised October 2010)
ManilaBOARD OF MIDWIFERYRecord of Actual Intravenous Insertions
Name of Applicant: MICHAEL ANGELO B. SEA School: MABINI COLLEGES, DAET CAMARINES NORTE
Name and Address of PatientCase No.Complete Diagnosis(Gravida_Para_)Date & Time PerformedFull Name, Address of Facility & Contact NumberCheck if Home Del.Supervised by:
Printed Name & Contact No.Position/ DesignationSignatureLicense No./Expiration Date
11.BRAGA ,LIZATUGOS PARACALE C.N.260781G3P2 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM6-10-133:45PMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
12.JINQUE,EDLYNGUMAMELA LABO C.N.280093G2P1 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM7-20-1310:20PMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
13.EVALDERASA,SHIELANICO PARACALE C.N.260485G3P2 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM6-5-132:03AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
14.ESTABYA,ANALYNTALUSAN PARACALE C.N.280661G2P1 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM8-15-134:35PMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
15.PALMERO,RONALIEMALAGNIT PARACALE C.N.281223G2P1 CEPHALOPELVIC IN LABOR PREGNANCY UTERINE FULLTERM8-28-134:45AMLABO,DISTRIC HOSPITAL CAMARINES NORTERAQUEL R. ABRERA09273779250CLINICAL INSTRUCTOR
L.N.-01347030379885E.D.-07-18-14
Note:1) For graduate midwives: Supervision must be by qualified faculty/clinical instructor.2) Registered Midwives/Clinical Instructors who supervise student midwives and affix their signature in this Form must present Certificate of Training on Suturing of Perineal lacerations to the Board pursuant to Board Resolutions No. 100, Series of 1993, dated December 1,1993SUBSCRIBED AND SWORN To before me this ____________________ at _____________________Affiant exhibiting to me his/her Residence Certificate No. 25927910 issued at DAET CAMARINES NORTE on JANUARY 3 2014.
CERTIFIED CORRECT:
Signature: ______________________ Date: ____________Printed Name: YOLANDA C.RUSTIA RN.RM,MAN oDesignation: PRINCIPAL OF MIDWIFERY oLicense Number:0175887/0112842 Expiry Date: SEPT. 25 2016
________________________________________________________ADMINISTERING OFFICER OR NOTARY CLUBAffixDocumentary Stamp(to be posted on the last page)