PRC Case Form Midwifery New 56198bd1c911e

PRC FORM No. 106 PROFESSIONAL REGULATION COMMISION

(Revised October 2010) Manila
BOARD OF MIDWIFERY
Record of Actual Deliveries Handled
Please Check:
Graduate Midwife Registered Nurse
Name of Applicant: MICHAEL ANGELO B. SEÑA School: MABINI COLLEGES, DAET CAMARINES NORTE
Check Supervised by:

Date & Full Name,
Case Complete Diagnosis if
Name and Address of Patient Time Address of Facility Printed Name & Position/ License No./
No. (Gravida_Para_) Home Signature
Performed & Contact Number Contact No. Designation Expiration Date
Del.
1.BATALAO,CATHERINE 270304 G1P0 CEPHALOPELVIC 6-24-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
CANAPAUAN, LABO C.N.
IN LABOR PREGNANCY HOSPITAL 09273779250 INSTRUCTOR 0379885
UTERINE FULLTERM 1:32 AM CAMARINES NORTE E.D.-07-18-14
2.MARMOLEJO,REINA 260941 G1P0 CEPHALOPELVIC 6-15-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
LABMIG PARACALE C.N.
UTERINE FULLTERM 11:35AM CAMARINES NORTE E.D.-07-18-14
3. ACLANO,ERLIN 220848 G1P0 CEPHALOPELVIC 7-6-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
IGANG PARACALE C.N.
4.TABUZO,JESSICA 27055 G1P0 CEPHALOPELVIC 6-30-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
MALANGCAO BASUD LABO C.N.
UTERINE FULLTERM CAMARINES NORTE E.D.-07-18-14
5.BANING VANESSA 198041 G1P0 CEPHALOPELVIC 7-31-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
FISHPORT PARACALE C.N.
6.FRANCISCO,HAZEL 280956 G1P0 CEPHALOPELVIC 8-14-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
TAWIG LABO C.N.
7.PAJARILLO,CHONA 290142 G1P0 CEPHALOPELVIC 8-20-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
MASALONG LABO C.N.
UTERINE FULLTERM 12:22PM CAMARINES NORTE E.D.-07-18-14
8.FINALLA,MARICEL 281742 G1P0 CEPHALOPELVIC 9-11-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
TUGOS,PARACALE C.N.
9.JALIMAO,MARIE 281846 G1P0 CEPHALOPELVIC 9-13-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
P.MUNT PARACALE
10.EREPALA,JOCELYN 281031 G1P0 CEPHALOPELVIC 10-28-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
MACOGON, LABO C.N.
(Continued at the Back)


Date & Full Name,
Case Complete Diagnosis if License No./
Name and Address of Patient Time Address of Facility Printed Name & Position/
No. (Gravida_Para_) Home Signature Expiration
Performed & Contact Number Contact No. Designation
Del. Date
11.BRAGA ,LIZA 260781 G3P2 CEPHALOPELVIC 6-10-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
TUGOS PARACALE C.N.
12.JINQUE,EDLYN 280093 G2P1 CEPHALOPELVIC 7-20-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
GUMAMELA LABO C.N.
13.EVALDERASA,SHIELA 260485 G3P2 CEPHALOPELVIC 6-5-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
NICO PARACALE C.N.
14.ESTABYA,ANALYN 280661 G2P1 CEPHALOPELVIC 8-15-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
TALUSAN PARACALE C.N.
15.PALMERO,RONALIE 281223 G2P1 CEPHALOPELVIC 8-28-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
MALAGNIT PARACALE C.N.
16.TOLINTINO,NINA 283423 G5P4 CEPHALOPELVIC 10-23-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
DAGUIT, LABO C.N
17.GAPOY,ALMA 283336 G2P1 CEPHALOPELVIC 10-19-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
BAAY LABO C.N.
18. ALAPAA,BELMELA 270056 G4P3 CEPHALOPELVIC 01-16-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
STA.SONA SUR JOSE PANGANIBAN
C.N.
19.MAGIMPA,NORJEAN 281980 G3P2 CEPHALOPELVIC 9-17-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
MASALONG LABO C.N.
20.NUDO,NERISSA 281394 G2P1 CEPHALOPELVIC 9-20-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
STA. ROSA NORTE JOSE
PANGANIBAN C.N.
Note:1) For graduate midwives: Supervision must be by qualified faculty/clinical instructor.
SUBSCRIBED AND SWORN To before me this ____________________ at CERTIFIED CORRECT:

_____________________Affiant exhibiting to me his/her Residence Certificate No.
25927910 issued at DAET CAMARINES NORTE on JANUARY 3 2014.
Signature: ______________________ Date: ____________
________________________________________________________
Affix Printed Name: YOLANDA C.RUSTIA RN.RM,MAN o
Documentary Stamp Designation: PRINCIPAL OF MIDWIFERY o
(to be posted on the last page) License Number: 0175887/0112842 Expiry Date: SEPT. 25 2016
ADMINISTERING OFFICER OR NOTARY CLUB

PRC FORM No. 107 PROFESSIONAL REGULATION COMMISION
BOARD OF MIDWIFERY
Record of Actual Suturing of Perineal Laceration
Please Check:
Graduate Midwife Registered Nurse

Date & Full Name,
Name and Address of Case Complete Diagnosis if License No./
Time Address of Facility Printed Name & Position/
Patient No. (Gravida_Para_) Home Signature Expiration
Del. Date
5.BANING VANESSA 198041 G1P0 CEPHALOPELVIC 7-31-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
FISHPORT PARACALE C.N.
6.FRANCISCO,HAZEL 280956 G1P0 CEPHALOPELVIC 8-14-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
TAWIG LABO C.N.
7.PAJARILLO,CHONA 290142 G1P0 CEPHALOPELVIC 8-20-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
MASALONG LABO C.N.
8.FINALLA,MARICEL 281742 G1P0 CEPHALOPELVIC 9-11-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
TUGOS,PARACALE C.N.
9.JALIMAO,MARIE 281846 G1P0 CEPHALOPELVIC 9-13-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
P.MUNT PARACALE
10.EREPALA,JOCELYN 281031 G1P0 CEPHALOPELVIC 10-28-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
MACOGON, LABO C.N.
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)

PRC FORM No. 107-A PROFESSIONAL REGULATION COMMISION

BOARD OF MIDWIFERY
Record of Actual Intravenous Insertions

Date & Full Name,
Name and Address of Case Complete Diagnosis if License No./
Time Address of Facility Printed Name & Position/
Patient No. (Gravida_Para_) Home Signature Expiration
Del. Date
11.BRAGA ,LIZA 260781 G3P2 CEPHALOPELVIC 6-10-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
TUGOS PARACALE C.N.
12.JINQUE,EDLYN 280093 G2P1 CEPHALOPELVIC 7-20-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
GUMAMELA LABO C.N.
13.EVALDERASA,SHIELA 260485 G3P2 CEPHALOPELVIC 6-5-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
NICO PARACALE C.N.
14.ESTABYA,ANALYN 280661 G2P1 CEPHALOPELVIC 8-15-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
TALUSAN PARACALE C.N.
15.PALMERO,RONALIE 281223 G2P1 CEPHALOPELVIC 8-28-13 LABO,DISTRIC RAQUEL R. ABRERA CLINICAL L.N.-0134703
MALAGNIT PARACALE C.N.
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
SUBSCRIBED 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:
Affix
Documentary Stamp Signature: ______________________ Date: ____________
(to be posted on the last page) Printed Name: YOLANDA C.RUSTIA RN.RM,MAN o
________________________________________________________ Designation: PRINCIPAL OF MIDWIFERY o
License Number: 0175887/0112842 Expiry Date: SEPT. 25 2016
ADMINISTERING OFFICER OR NOTARY CLUB

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PRC FORM No. 106 PROFESSIONAL REGULATION COMMISION

Check Supervised by:

(Continued at the Back)

Check Supervised by:

Note:1) For graduate midwives: Supervision must be by qualified faculty/clinical instructor.

SUBSCRIBED AND SWORN To before me this ____________________ at CERTIFIED CORRECT:

Check Supervised by:

(See back page)

PRC FORM No. 107-A PROFESSIONAL REGULATION COMMISION

Check Supervised by:

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