Professional Regulation Commission

RECORD OF ACTUAL SUTURING OF PERINEAL LACERATIONS

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PRBSEC-48
Rev. 00
January 24, 2020
Page 1 of 1
 Professional Regulation Commission

RECORD OF ACTUAL INTRAVENOUS FLUID INSERTIONS

1. 2022201 Krestil, 22 years old, G2P2 (2002). PU 38 weeks & 04/14/22 Happy Family Midwife Clinic Stephanie Z. Abriol Clinical Instructor RM- 0162086
Krestil L. Suralta 2 days, cephalic, delivered NSD to a live baby girl, 11:34 AM Jasaan Mis. Or RM, BSM 12/25/2024
APGAR= 9, BW= 3000 grams with 2nd degree, 89062777 09359206729
Zone 1, Bangon-
laceration and repaired.
Bangon
Patrocinio
Claveria Mis. Or
2.Maria Rita A. 2022585 Maria Rita, 27 years old, G2P2 (2002). PU 38 weeks 06/01/22 Happy Family Midwife Clinic Stephanie Z. Abriol Clinical Instructor RM- 0162086
& 4 days, cephalic, delivered NSD to a live baby 09:08 AM Jasaan Mis. Or RM, BSM 12/25/2024
Paduganao
girl, APGAR= 9, BW= 2900 grams and repair of 1st 89062777 09359206729
Hinaplanan degree, laceration.
Claveria Mis. Or
3.Cherry Mae 2022725 Cherry Mae, 24 years old, G2P2 (2002). PU 38 07/25/22 Happy Family Midwife Clinic Stephanie Z. Abriol Clinical Instructor RM- 0162086
weeks & 2 days, cephalic, delivered NSD to a live 07:31 PM Jasaan Mis. Or RM, BSM 12/25/2024
Pamelara
baby boy, APGAR= 9, BW=2800 grams and repair 89062777 09359206729
Sta. Ana of 1st degree, laceration.
Tagoloan Mis. Or
4.Gina M. Adolfo 2022344 Gina, 32 years old, G2P2(2002). PU 38 weeks & 2 09/23/22 Happy Family Midwife Clinic Stephanie Z. Abriol Clinical Instructor RM- 0162086
days, cephalic, delivered NSD to a live baby girl, 04:13 AM Jasaan Mis. Or RM, BSM 12/25/2024
Zone 5,
APGAR=9, BW=2800 grams and repair of 1st 89062777 09359206729
Bobontugan Jasaa degree, laceration.
Mis. Or
5.Reina c. 2022441 Reina, 25 years old, G3P3(3003). PU 38 weeks & 3 09/27/22 Happy Family Midwife Clinic Stephanie Z. Abriol Clinical Instructor RM- 0162086
days, cephalic, delivered NSD to a live baby boy, 07:52 PM Jasaan Mis. Or RM, BSM 12/25/2024
Sentasas
APGAR=9, BW=3100 grams and repair of 1st 89062777 09359206729
Zone 1, degree, laceration.
Luzbanzon Jasaan
Mis. Or
Note: 1) Registered Midwives/Clinical Instructors who supervise Students/Graduate Midwives/Registered Nurses and affix their signature in this Form must present
Certificate of Training on Expanded Functions of Midwife (R.A. 7392) pursuant to Board Resolution No. 07, Series of 2017, dated September 8, 2017.

(See back page)

PRBSEC-48
Rev. 00
January 24, 2020
Page 1 of 2
 Professional Regulation Commission

RECORD OF ACTUAL SUTURING OF PERINEAL LACERATIONS

Name of Applicant: ARENDAIN, SHEILA MAE M. School: Tagoloan Community College
Supervised by:
Name and Address of Case Complete Diagnosis Signature
Patient No. Prin
Designati
Add
ress Expira
Faci Con

Con

mbe

1. Maria 2022517 Maria Guadalope, 24 years old, G2P2 (2002). PU 39 04/27/22 Happy Family Midwife Stephanie Z. Abriol RM- 0162086
weeks & 4 days, cephalic, in labor, delivered NSD to a 01: 25 AM Clinic RM, BSM 12/25/2024
Guadalope B.
live baby girl, BW= 3000 grams and with mild Jasaan Mis. Or 09359206729 Clinical Instructor
Clerigo hemorrhage after the delivery of placenta. 89062777
Upper Jasaan
Mis. Or

2. Mary Jane 2022677 Mary Jane, 34 years old, G3P3 (3003). PU 40 weeks and 05/13/22 Happy Family Midwife Stephanie Z. Abriol RM- 0162086
1 day, cephalic, in labor, delivered NSD to a live baby 06: 55 PM Clinic RM, BSM 12/25/2024
Glarino
girl, BW= 3400 grams, and with blood pressure of 90/60 Jasaan Mis. Or 09359206729 Clinical Instructor
Zone 1, mmHg. 89062777
Luzbanzon, Jasaan
Mis. Or

3. Florence V. 2022077 Florence, 33 years old, G3P3 (3003). PU 39 weeks & 3 07/06/22 Happy Family Midwife Stephanie Z. Abriol RM- 0162086
days, cephalic, in labor, delivered NSD to a live baby 05:55 PM Clinic RM, BSM 12/25/2024
Bugto girl, BW=3200 grams, and with mild hemorrhage after Jasaan Mis. Or 09359206729 Clinical Instructor
Zone 5, Igpit Luzbanzon, Jasaan the delivery of placenta 89062777
Mis. Or
4. Sheena Mae 20220474 Sheena Mae, 27 years old, G2P2(2002). PU 40 weeks & 07/28/22 Happy Family Midwife Stephanie Z. Abriol RM- 0162086
1 day, cephalic, in labor, delivered NSD to a live baby 08:33 PM Clinic RM, BSM 12/25/2024
Octobre
boy, BW= 3300 grams, and with mild hemorrhage after Jasaan Mis. Or 09359206729 Clinical Instructor
Aplaya, Jasaan the delivery of placenta. 89062777
Mis.Or
5.Alzona D. 2022492 Alzona, 22 years old, G2P2 (2002). PU 40 weeks & 2 09/20/22 Happy Family Midwife Stephanie Z. Abriol RM- 0162086
days, cephalic, in labor, delivered NSD to a live baby 07:15 AM Clinic RM, BSM Clinical Instructor 12/25/2024
Tinapay
boy, BW= 3000 grams and with blood pressure of 90/60 Jasaan Mis. Or 09359206729
PRBSEC-48
Rev. 00
January 24, 2020
Page 1 of 1
 Professional Regulation Commission

RECORD OF ACTUAL INTRAVENOUS FLUID INSERTIONS

S mmHg. 89062777
an Antonio Jasaan
Mis. Or
Note: 1) Registered Midwives/Clinical Instructors who supervise Students/Graduate Midwives/Registered Nurses and affix their signature in this Form must present a
Certificate of Training on Expanded Functions of Midwife (R.A. 7392) pursuant to Board Resolution No. 07, Series of 2017, dated September 8, 2017.

CERTIFIED CORRECT:

Signature: Date:
Printed Name:
Affix Designation: ____________________________ Number:
Expiry Date:
Documentary Stamp
(to be posted on the last page)

PRBSEC-48
Rev. 00
January 24, 2020
Page 1 of 2