Escolar Documentos
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Manila
BOARD OF MIDWIFERY
Record of Actual Deliveries Handled
Please Check if applicant is:
SUBSCRIBED AND SWORN to before me this _____________________ at ______________________Affiant exhibiting to me his/her Residence
Certificate No.________________
Issued at_______________on___________________.
CERTIFIED CORRECT:
__________________________________
Administering officer or Notary Public Signature: ____________________Date: _____________
Affix Printed Name: MAGDALENA L. LICMOAN RM, MAT
Designation: PRINCIPAL___________________
Documentary Lic. No.: 0038022 Expiry Date: SEPTEMBER 24, 2020
(to be posted on the last
page)
PROFESSIONAL REGULATION COMMISSION
Manila
BOARD OF MIDWIFERY
Record of Actual Repair of Perineal Laceration
Supervised by:
Name of Patient Case Complete Diagnosis Date & Time Full Name, Address of
Number Facility & Contact Number Check
Gravida-Para Performed if Home Printed Name & Position/ Signature License
Del.
Contact No Designation No./Expiration
Date
1. Guda, Eunilyn Gravida 2 Para 2 Pregnancy Uterine 37 wks Jan 11, 2018
Pagamutan ng Dasmarinas
Blk A-12 Lot 2 San Luis II 00258 AOG via Normal Spontaneous Delivery to 6:00 am Burol 1, City of Dasmarinas, Cavite Anna Sincerra D. Quinio, RM, RN, MAN Clinical 0084589
Sept. 1, 2020
Dasmariňas, Cavite an alive Baby Boy, 3800gms @ 4:37 pm 09175790079 Instructor
with 2nd degree laceration
2. Clapis, Libunao Gravida 1 Para 1 Pregnancy Uterine 40wks Jan 29, 2018
Pagamutan ng Dasmarinas
Blk.135 Lot 36 Ph.1 Mabuhay 00274 AOG via Normal Spontaneous Delivery to 7:00am Burol 1, City of Dasmarinas, Cavite Anna Sincerra D. Quinio, RM, RN, MAN Clinical 0084589
Subdivision Palipara 3 Sept. 1, 2020
an alive Baby Boy, 3000gms @ 1:30 pm 09175790079 Instructor
Dasmariňas, Cavite
with 2nd degree laceration
3. Castillo, Cristhel Gravida 1 Para 1 Pregnancy Uterine 41 wks Feb 08, 2018
Pagamutan ng Dasmarinas
Private Lot Brgy. Burol 3 00281 AOG via Normal Spontaneous Delivery to 11:32 pm Burol 1, City of Dasmarinas, Cavite Anna Sincerra D. Quinio, RM, RN, MAN Clinical 0084589
Sept. 1, 2020
Dasmariňas, Cavite. an alive Baby Girl, 2700gms @ 11:32 pm 09175790079 Instructor
with 1st degree laceration
4. Mendoza, Jennifer Gravida 1 Para 1 Pregnancy Uterine 39 wks
Pagamutan ng Dasmarinas
0700 Almond St. Summit 00295 AOG via Normal Spontaneous Delivery to Mar 10, 2018 Burol 1, City of Dasmarinas, Cavite Anna Sincerra D. Quinio, RM, RN, MAN Clinical 0084589
Sept. 1, 2020
Circle Muntilupa City an alive Baby Girl, 3600gms @ 2:35 am 2:35 pm 09175790079 Instructor
with 2nd degree laceration
5. Sandigan, Maristel Gravida 1 Para 1 Pregnancy Uterine 38 wks
Pagamutan ng Dasmarinas
Blk. 19 Lot I Luzviminda 00322 and 2 days AOG via Normal Spontaneous Apr 26, 2018 Burol 1, City of Dasmarinas, Cavite Anna Sincerra D. Quinio, RM, RN, MAN Clinical 0084589
Sept. 1, 2020
II Dasmariňas, Cavite. Delivery to an alive Baby Boy, 3100gms 11:20pm 09175790079 Instructor
11:20pm with 1st degree laceration
Note: For graduate midwives: Supervision must be by qualified faculty/clinical instructor
SUBSCRIBED AND SWORN to before me this _____________________ at ______________________Affiant exhibiting to me his/her Residence
Certificate No.________________
Issued at_______________on___________________.
Magdalena L. Licmoan, RM, BSND, MAT Remarks: _________________ Anna Sincerra D. Quinio, RM., RN, MAN
Principal, School of Midwifery Clinical Instructor
License no:0038022 License no: 0084589
Valid Until: SEPTEMBER 24, 2020 Valid Until: September 1, 2020
PROFESSIONAL REGULATION COMMISSION
Manila
BOARD OF MIDWIFERY
Record of Actual IV Insertion/Infusion
Please Check if applicant is:
Supervised by:
Name of Patient Case Complete Diagnosis Date & Full Name, Address of
Number Facility & Contact Check
Gravida-Para Time if Home
Number Printed Name & Position/ Signature License
Performed Del.
Contact No Designation No./Expiration
Date
1. Dicen, Karen Gravida 6 Para 5 Pregnancy Uterine 40 wks
Jan 30, 2018 Pagamutan ng Dasmarinas
B-167 Lot 27 ph. 4 Paliparan 00276 and 3 days AOG via Normal Spontaneous Burol 1, City of Dasmarinas, Cavite Anna Sincerra D. Quinio, RM, RN, MAN Clinical 0084589
III Dasmariňas, Cavite Delivery to an alive Baby Girl, 3600gms @ 3:10 pm Instructor Sept. 1, 2020
09175790079
3:10 pm
2. Ebia, Marie Cris 00290 Gravida 5 Para 5 Pregnancy Uterine 38 wks Pagamutan ng Dasmarinas
AOG via Normal Spontaneous Delivery to Feb 21, 2018 Burol 1, City of Dasmarinas, Cavite Clinical 0084589
Blk 7 Lot 34 Ph.9 Golden Anna Sincerra D. Quinio, RM, RN, MAN
9:55 am Sept. 1, 2020
City Dasmariňas, Cavite. an alive Baby Girl @ 9:55 am 09175790079 Instructor
3. Columbus, Jona-Anne 00303 Gravida 3 Para 3 Pregnancy Uterine 41 wks Pagamutan ng Dasmarinas
#600 Happy Road Kaibagan AOG via Normal Spontaneous Delivery to Mar 31, 2018 Burol 1, City of Dasmarinas, Cavite Clinical 0084589
3:50am
Anna Sincerra D. Quinio, RM, RN, MAN Sept. 1, 2020
tagaytay City an alive Baby Girl, 2600gms 3:50 am 09175790079 Instructor
4. Bayquen, Liberty 00308 Gravida 3 Para 3 Pregnancy Uterine 38 wks Pagamutan ng Dasmarinas
and 6 days AOG via Normal Spontaneous Apr 07, 2018 Burol 1, City of Dasmarinas, Cavite Clinical 0084589
Blk.18 Lot 3 and 4 Bahay Anna Sincerra D. Quinio, RM, RN, MAN
Delivery to an alive Baby Boy, 3400gms 7:15 am Instructor Sept. 1, 2020
Pangarap Sampaloc IV 09175790079
Dasmariňas, Cavite. 7:15 am
5. Vista, Julie Anne 00315 Gravida 3 Para 3 Pregnancy Uterine 39 wks Pagamutan ng Dasmarinas
Blk. 19 Lot 26 Victoria and 2 days AOG via Normal Spontaneous Apr 16, 2018 Burol 1, City of Dasmarinas, Cavite Clinical 0084589
8:10am boy
Anna Sincerra D. Quinio, RM, RN, MAN Sept. 1, 2020
Reyes Dasmariňas, Cavite. Delivery to an alive Baby Boy, 3500gms 09175790079 Instructor
8:10 am
SUBSCRIBED AND SWORN to before me this _____________________ at ______________________Affiant exhibiting to me his/her Residence
Certificate No.________________
Issued at_______________on___________________.
CERTIFIED CORRECT:
__________________________________
Administering officer or Notary Public Signature: ____________________ Date: _____________
Printed Name: MAGDALENA L. LICMOAN RM, MAT
Designation: PRINCIPAL___________________
Lic. No.: 0038022Expiry Date::SEPTEMBER 24, 2020