PROFESSIONAL REGULATION COMMISSION

Manila
BOARD OF MIDWIFERY
RECORD OF ACTUAL DELIVERIES HANDLED
Please Check if Applicant is:
Graduate Midwife Registered Nurse
Name of Applicant: ABABON, CHERRYL MAE PAGENTE School: SCHOLA DE SAN JOSE (Formerly: Provincial Technical Institute for Southern Mindanao)
Case Date and Full Name, Address of Facility & Check if Supervised by:
Name and Complete Diagnosis (Gravida __ Para __) No. Time Contact Number Home
Performed Delivery Printed Name & Position/ Signature License No./
Contact No. Designation Exp. Date
1. Rovelyn, 30 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
40 weeks and 1 day Age of Gestation, cephalic in labor, delivered 2020-001 01/04/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Normal Spontaneous Delivery to a live Baby girl with an Apgar Score of 12:59 P.M 09094616941 BCHS Instructor 11/17/2022
9, Birth Weight 3900 grams. 09094616941
2. Jovelyn 38 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home
weeks Age of Gestation, cephalic in labor, delivered Normal 2020-002 01/06/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 9, Birth 03:20 A.M. 09094616941 BCHS Instructor 11/17/2022
Weight 2600 grams. 09094616941
3. Alma, 34 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home
weeks and 2 days Age of Gestation, cephalic in labor, delivered Normal 2020-004 01/08/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8, Birth 03:30 P.M. 09094616941 BCHS Instructor 11/17/2022
Weight 3000 grams. 09094616941
4. Jenevie, 19 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 40 Emelia Ancuna- Amante Birthing Home
weeks Age of Gestation, cephalic in labor, delivered Normal 2020-007 01/11/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 9, Birth 02:47 P.M. 09094616941 BCHS Instructor 11/17/2022
Weight 3400 grams. 09094616941
5. Jessa Mae, 24 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
39 weeks and 4 days Age of Gestation, cephalic in labor, delivered 2020-008 01/12/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Normal Spontaneous Delivery to a live Baby girl with an Apgar Score of 09:26 A.M. 09094616941 BCHS Instructor 11/17/2022
9, Birth Weight 2700 grams. 09094616941
6. Angeline, 22 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
41 weeks Age of Gestation, cephalic in labor, delivered Normal 2020-009 01/12/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8, Birth 10:45 P.M. 09094616941 BCHS Instructor 11/17/2022
Weight 2500 grams. 09094616941
7. Rovelyn, 24 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
39 weeks and 4 days Age of Gestation, cephalic in labor, delivered 2020-010 01/13/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Normal Spontaneous Delivery to a live Baby girl with an Apgar Score of 07:24 P.M. 09094616941 BCHS Instructor 11/17/2022
8, Birth Weight 2600 grams. 09094616941
8. Teresame, 29 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
38 weeks and 1 day Age of Gestation, cephalic in labor, delivered 2020-011 01/16/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Normal Spontaneous Delivery to a live Baby boy with an Apgar Score of 12:45 A.M. 09094616941 BCHS Instructor 11/17/2022
8, Birth Weight 2500 grams. 09094616941
9. Rosemary, 29 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
40 weeks and 1 day Age of Gestation, cephalic in labor, delivered 2020-015 01/17/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Normal Spontaneous Delivery to a live Baby boy with an Apgar Score of 05:00 A.M. 09094616941 BCHS Instructor 11/17/2022
9, Birth Weight 3000 grams. 09094616941
10. Nigel, 20 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home
 weeks Age of Gestation, cephalic in labor, delivered Normal 2020-017 01/18/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Spontaneous Delivery to a live Baby girl with an Apgar Score of 9, Birth 07:00 A.M. 09094616941 BCHS Instructor 11/17/2022
Weight 2500 grams. 09094616941
Case Date and Full Name, Address of Facility & Check if Supervised by:
Name and Complete Diagnosis (Gravida __ Para __) No. Time Contact Number Home
Performed Delivery Printed Name & Position/ Signature License No./
Contact No. Designation Exp. Date
11. Zita Grace, 36 years old, Gravida 2 Para 2 (2002). Pregnancy Emelia Ancuna- Amante Birthing Home
Uterine 40 weeks Age of Gestation, cephalic in labor, delivered Normal 2020-018 01/18/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 9, Birth 02:27 P.M 09094616941 BCHS Instructor 11/17/2022
Weight 3700 grams. 09094616941
12. Ana Leah, 35 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
40 weeks Age of Gestation, cephalic in labor, delivered Normal 2020-020 01/20/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8, Birth 07:25 A.M. 09094616941 BCHS Instructor 11/17/2022
Weight 3600 grams. 09094616941
13. Catherine, 24 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
40 weeks and 4 days Age of Gestation, cephalic in labor, delivered 2020-021 01/20/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Normal Spontaneous Delivery to a live Baby girl with an Apgar Score of 10:35 P.M. 09094616941 BCHS Instructor 11/17/2022
9, Birth Weight 2600 grams. 09094616941
14. Jecel, 24 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home
weeks and 5 days Age of Gestation, cephalic in labor, delivered Normal 2020-022 01/21/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Spontaneous Delivery to a live Baby girl with an Apgar Score of 9, Birth 04:23 A.M. 09094616941 BCHS Instructor 11/17/2022
Weight 3700 grams. 09094616941
15. Queenjoy, 28 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
40 weeks Age of Gestation, cephalic in labor, delivered Normal 2020-026 01/23/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Spontaneous Delivery to a live Baby girl with an Apgar Score of 8, Birth 06:00 A.M. 09094616941 BCHS Instructor 11/17/2022
Weight 3200 grams. 09094616941
16. Helen, 38 years old, Gravida 4 Para 4 (4004). Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home
weeks and 1 day Age of Gestation, cephalic in labor, delivered Normal 2020-028 01/23/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Spontaneous Delivery to a live Baby girl with an Apgar Score of 8, Birth 10:55 P.M. 09094616941 BCHS Instructor 11/17/2022
Weight 2800 grams. 09094616941
17. Renz, 20 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 37 Emelia Ancuna- Amante Birthing Home
weeks and 4 days Age of Gestation, cephalic in labor, delivered Normal 2020-031 01/27/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8, Birth 05:25 A.M. 09094616941 BCHS Instructor 11/17/2022
Weight 3100 grams. 09094616941
18. Cheerry Mae, 27 years old, Gravida 2 Para 2 (2002). Pregnancy Emelia Ancuna- Amante Birthing Home
Uterine 40 weeks and 3 days Age of Gestation, cephalic in labor, 2020-032 01/28/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
delivered Normal Spontaneous Delivery to a live Baby girl with an Apgar 04:45 P.M. 09094616941 BCHS Instructor 11/17/2022
Score of 9, Birth Weight 2500 grams. 09094616941
19. Jinjin, 23 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home
weeks Age of Gestation, cephalic in labor, delivered Normal 2020-038 02/09/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 9, Birth 11:50 P.M. 09094616941 BCHS Instructor 11/17/2022
Weight 2600 grams. 09094616941
20. Prechie, 23 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
39 weeks and 2 days Age of Gestation, cephalic in labor, delivered 2020-040 02/14/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Normal Spontaneous Delivery to a live Baby boy with an Apgar Score of 03:45 P.M. 09094616941 BCHS Instructor 11/17/2022
8, Birth Weight 3100 grams. 09094616941
NOTE: 1.) 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 Polomolok, South Cotabato on _____________.

_______________________________ Affix CERTIFIED CORRECT:

Administering Officer or Notary Public
Documentary Stamp
Signature: ______________ Date: _______________
Printed Name: WILMA T. HERAMIL, MD
Designation: Principal/Chairman Health Services Education Unit
License No.: 0078733 Expiry Date: 11/17/2024
 PROFESSIONAL REGULATION COMMISSION
Manila
BOARD OF MIDWIFERY
RECORD OF ACTUAL INTERNAL EXAMINATION
Please Check if Applicant is:
Graduate Midwife Registered Nurse
Name of Applicant: ABABON, CHERRYL MAE PAGENTE School: SCHOLA DE SAN JOSE (Formerly: Provincial Technical Institute for Southern Mindanao)
Case Date and Full Name, Address of Facility & Check if Supervised by:
Name and Complete Diagnosis (Gravida __ Para __) No. Time Contact Number Home
Performed Delivery Printed Name & Position/ Signature License No./
Contact No. Designation Exp. Date
1. Rovelyn, 30 years old, Gravida 3 Para 2 (2002). Pregnancy Uterine 40 Emelia Ancuna- Amante Birthing Home
weeks and 1 day Age of Gestation, cephalic in labor, 9cm dilated, 90% 2020-001 01/04/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
effaced, Intact Bag of Water, station +2 11:50 A.M 09094616941 BCHS Instructor 11/17/2022
09094616941
2. Jovelyn, 38 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home
weeks Age of Gestation, cephalic in labor, 10cm dilated, 100% effaced, 2020-002 01/06/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Ruptured Bag of Water, Amniotic Fluid meconium stained in color, 03:07 A.M. 09094616941 BCHS Instructor 11/17/2022
station +3. 09094616941
3. Alma, 34 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home
weeks and 2 days Age of Gestation, cephalic in labor, 7cm dilated, 80% 2020-004 01/08/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
effaced, Ruptured Bag of Water, Amniotic Fluid clear in color, station +1. 12:33 P.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
4. Jenevie, 19 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine 40 Emelia Ancuna- Amante Birthing Home
weeks Age of Gestation, cephalic in labor, 10cm dilated, 100% effaced, 2020-007 01/11/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Ruptured Bag of Water, Amniotic Fluid clear in color , station +3. 02:33 P.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
5. Jessa Mae, 24 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
39 weeks and 4 days Age of Gestation, cephalic in labor, 8cm dilated, 2020-008 01/12/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
80% effaced, Ruptured Bag of Water, Amniotic Fluid clear in color, 07:20 A.M. 09094616941 BCHS Instructor 11/17/2022
station +1. 09094616941
6. Angeline, 22 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
41 weeks Age of Gestation, cephalic in labor, 10cm dilated,100% 2020-009 01/12/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
effaced, Ruptured Bag of Water, Amniotic Fluid clear in color, station +4. 10:15 P.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
7. Rovelyn, 24 years old, Gravida 3 Para 2 (2002). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home
weeks and 4 days Age of Gestation, cephalic in labor, 8cm dilated, 80% 2020-010 01/13/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
effaced, Intact Bag of Water, station +1. 05:30 P.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
8. Teresame, 29 years old, Gravida 3 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
38 weeks and 1 day Age of Gestation, cephalic in labor, 6cm dilated, 2020-011 01/15/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
85% effaced, Ruptured Bag of Water, Amniotic Fluid clear in color, 09:50 P.M. 09094616941 BCHS Instructor 11/17/2022
station 0. 09094616941
9. Rosemary, 29 years old, Gravida 3 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
40 weeks and 1 day Age of Gestation, cephalic in labor, 8cm dilated, 2020-015 01/17/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
90% effaced, Intact Bag of Water, station +1. 03:13 A.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
10. Nigel, 20 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home
 weeks Age of Gestation, cephalic in labor 10cm dilated, 100% effaced, 2020-017 01/18/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Intact Bag of Water, station +4. 06:42 A.M. 09094616941 BCHS Instructor 11/17/2022
09094616941

Case Date and Full Name, Address of Facility & Check Supervised by:
Name and Complete Diagnosis (Gravida __ Para __) No. Time Contact Number if Home
Performe Deliver Printed Name & Position/ Signature License No./
d y Contact No. Designation Exp. Date
11. Zita Grace, 36 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
40 weeks Age of Gestation, cephalic in labor, 8cm dilated, 80% effaced, 2020-018 01/18/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Intact Bag of Water, station +1. 01:20 P.M 09094616941 BCHS Instructor 11/17/2022
09094616941
12. Ana Leah, 35 years old, Gravida 3 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
40 weeks Age of Gestation, cephalic in labor, 7cm dilated, 80% effaced, 2020-020 01/20/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Intact Bag of Water, station +1. 05:40 A.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
13. Catherine, 24 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
40 weeks and 4 days Age of Gestation, cephalic in labor, 8cm dilated, 2020-021 01/20/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
90% effaced, Ruptured Bag of Water, Amniotic Fluid meconium stained 08:40 P.M. 09094616941 BCHS Instructor 11/17/2022
in color, station +1. 09094616941
14. Jecel, 24 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home
weeks and 5 days Age of Gestation, cephalic in labor, 8cm dilated, 90% 2020-022 01/21/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
effaced, Intact Bag of Water, station +1. 02:30 A.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
15. Queenjoy, 28 years old, Gravida 3 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
40 weeks Age of Gestation, cephalic in labor, 9cm dilated, 90% effaced, 2020-026 01/23/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Intact Bag of Water, station +2. 05:08 A.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
16. Helen, 38 years old, Gravida 4 Para 3 (3003). Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home
weeks and 1 day Age of Gestation, cephalic in labor, 10cm dilated, 100% 2020-028 01/23/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
effaced, Ruptured Bag of Water, Amniotic Fluid clear in color, station +3 10:37 P.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
17. Renz, 20 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine 37 Emelia Ancuna- Amante Birthing Home
weeks and 4 days Age of Gestation, cephalic in labor 8cm dilated, 85% 2020-031 01/27/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
effaced, Ruptured Bag of Water, Amniotic Fluid clear in color, station +1 03:25 A.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
18. Cheerry Mae, 27 years old, Gravida 2 Para 1 (1001). Pregnancy Emelia Ancuna- Amante Birthing Home
Uterine 40 weeks and 2 days Age of Gestation, cephalic in labor, 9cm 2020-032 01/28/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
dilated, 90% effaced, Ruptured Bag of Water, Amniotic Fluid meconium 03:40 P.M. 09094616941 BCHS Instructor 11/17/2022
stained in color, station +2 09094616941
19. Jinjin, 23 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home
weeks Age of Gestation, cephalic in labor, 10cm dilated, 100% effaced, 2020-038 02/09/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
Ruptured Bag of Water, Amniotic Fluid clear in color, station +4 11:45 P.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
20. Prechie, 23 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home
weeks and 2 days Age of Gestation, cephalic in labor, 8cm dilated, 90% 2020-040 02/14/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM Clinical 0108299
effaced, Intact Bag of Water, station +1 01:40 P.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
NOTE: 1.) 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 Polomolok, South Cotabato on _____________.

_______________________________ Affix CERTIFIED CORRECT:

Administering Officer or Notary Public Documentary Stamp
Signature: ______________ Date: _______________
Printed Name: WILMA T. HERAMIL, MD
Designation: Principal/Chairman Health Services Education Unit
License No.: 0078733 Expiry Date: 11/17/2024
PROFESSIONAL REGULATION COMMISSION
Manila
BOARD OF MIDWIFERY
RECORD OF ACTUAL SUTURING OF PERINEAL LACERATIONS
Please Check if Applicant is:
Graduate Midwife Registered Nurse
Name of Applicant: ABABON, CHERRYL MAE PAGENTE School: SCHOLA DE SAN JOSE (Formerly: Provincial Technical Institute for Southern Mindanao)
Case Date and Full Name, Address of Facility & Check if Supervised by:
Name and Complete Diagnosis (Gravida __ Para __) No. Time Contact Number Home
Performed Delivery Printed Name & Position/ Signature License No./
Contact No. Designation Exp. Date
1. Rovelyn, 30 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 40
weeks and 1 day Age of Gestation, cephalic presentation, delivered Normal 2020-001 01/04/2020 Emelia Ancuna- Amante Birthing Home Clinical
EMELIA A. AMANTE, RM 0108299
Spontaneous Delivery to a live Baby girl at 12:59 P.M., with an Apgar Score 01:26 P.M Polomolok, South Cotabato Instructor
BCHS 11/17/2022
of 9, Birth Weight 3900 grams. Placenta delivered at 01:04 PM, suture 09094616941
started 01:07 PM – suture ended 01:26 PM. Second Degree of perineal 09094616941
laceration repaired.
2. Jenevie, 19 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 40
weeks Age of Gestation, cephalic presentation, delivered Normal 2020-007 01/11/2020 Emelia Ancuna- Amante Birthing Home Clinical
EMELIA A. AMANTE, RM 0108299
Spontaneous Delivery to a live Baby boy at 02:47 P.M., with an Apgar Score 03:12 P.M. Polomolok, South Cotabato Instructor
BCHS 11/17/2022
of 9, Birth Weight 3400 grams. Placenta delivered at 02:52 PM, suture 09094616941
started 02:55 PM – suture ended 03:12 PM. First Degree of perineal 09094616941
laceration repaired.
3. Zita Grace, 36 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 40
weeks Age of Gestation, cephalic presentation, delivered Normal 2020-018 01/18/2020 Emelia Ancuna- Amante Birthing Home Clinical
EMELIA A. AMANTE, RM 0108299
Spontaneous Delivery to a live Baby girl at 02:27 P.M., with an Apgar Score 02:53 P.M. Polomolok, South Cotabato Instructor
BCHS 11/17/2022
of 8-9, Birth Weight 3700 grams. Placenta delivered at 02:33 PM, suture 09094616941
started 02:36 PM – suture ended 02:53 PM. First Degree of perineal 09094616941
laceration repaired.
4. Jecel, 24 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39
weeks and 5 days Age of Gestation, cephalic presentation, delivered Normal 2020-022 01/21/2020 Emelia Ancuna- Amante Birthing Home Clinical
EMELIA A. AMANTE, RM 0108299
Spontaneous Delivery to a live Baby girl at 04:23 A.M., with an Apgar Score 04:52 A.M. Polomolok, South Cotabato Instructor
BCHS 11/17/2022
of 9, Birth Weight 3700 grams. Placenta delivered at 04:28 AM, suture 09094616941
started 04:32 AM – suture ended 04:52 AM. Second Degree of perineal 09094616941
laceration repaired.
5. Prechie, 23 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39
weeks and 2 days Age of Gestation, cephalic presentation, delivered Normal 2020-040 02/14/2020 Emelia Ancuna- Amante Birthing Home Clinical
EMELIA A. AMANTE, RM 0108299
Spontaneous Delivery to a live Baby boy at 03:45 P.M., with an Apgar Score 04:10 P.M. Polomolok, South Cotabato Instructor
BCHS 11/17/2022
of 8, Birth Weight 3100 grams. Placenta delivered at 03:49 PM, suture 09094616941
started 03:53 PM – suture ended 04:10 PM. First Degree of perineal 09094616941
laceration repaired.
NOTE: 1.) For Graduate Midwives: Supervision must be by qualified Faculty / Clinical Instructor.
2. Registered Midwives / Clinical Instructors who supervise the student midwives affix their signatures in this form must present a certificate of
Training of Perineal Lacerations to the Board pursuant to Board Resolution 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. ________________ issued at Polomolok, South Cotabato on _____________.
_______________________________ CERTIFIED CORRECT:
Administering Officer or Notary Public Signature: ______________ Date: _______________
Printed Name: WILMA T. HERAMIL, MD
Designation: Principal/Chairman Health Services Education Unit
License No.: 0078733 Expiry Date: 11/17/2024

PROFESSIONAL REGULATION COMMISSION

Manila
BOARD OF MIDWIFERY
RECORD OF ACTUAL INTRAVENOUS INSERTION Please Check if Applicant is:
Graduate Midwife Registered Nurse
Name of Applicant: ABABON, CHERRYL MAE PAGENTE School: SCHOLA DE SAN JOSE (Formerly: Provincial Technical Institute for Southern Mindanao)
Case Date and Full Name, Address of Facility & Check if Supervised by:
Name and Complete Diagnosis (Gravida __ Para __) No. Time Contact Number Home
Performed Delivery Printed Name & Position/ Signature License No./
Contact No. Designati Exp. Date
on
1. Alma, 34 years old, Gravida 2 Para 1 (1001), Pregnancy Uterine 38
weeks and 2 days Age of Gestation, cephalic in beginning labor. 2020-004 01/04/2020 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM Clinical 0108299
Alma, 34 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 38 01:30 P.M Polomolok, South Cotabato BCHS Instructor 11/17/2022
weeks and 2 days Age of Gestation, cephalic Normal Spontaneous 09094616941 09094616941
Delivery to an alive term Baby boy, Birth Weight 3000 grams, Premature
Rupture of Membrane x 3 hours.
2. Jessa Mae, 24 years old, Gravida 2 Para 1 (1001), Pregnancy Uterine
39 weeks and 4 days Age of Gestation, cephalic in beginning labor. 2020-008 01/12/2020 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM Clinical 0108299
Jessa Mae, 24 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 07:15 A.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
39 weeks and 4 days Age of Gestation, cephalic Normal Spontaneous 09094616941 09094616941
Delivery to an alive term Baby girl, Birth Weight 2700 grams, Premature
Rupture of Membrane x 2 hours.
3. Teresame, 29 years old, Gravida 3 Para 2 (2002), Pregnancy Uterine
38 weeks and 1 day Age of Gestation, cephalic in beginning labor. 2020-011 01/16/2020 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM Clinical 0108299
Teresame, 29 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 09:40 P.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
38 weeks and 1 day Age of Gestation, cephalic Normal Spontaneous 09094616941 09094616941
Delivery to an alive term Baby boy, Birth Weight 2500 grams, Premature
Rupture of Membrane x 4 hours.
4. Catherine, 24 years old, Gravida 2 Para 1 (1001), Pregnancy Uterine
40 weeks and 4 days Age of Gestation, cephalic in beginning labor. 2020-021 01/20/2020 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM Clinical 0108299
Catherine, 24 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 08:30 P.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
40 weeks and 4 days Age of Gestation, cephalic Normal Spontaneous 09094616941 09094616941
Delivery to an alive term Baby girl, Birth Weight 2600 grams, Premature
Rupture of Membrane x 2 hours with meconium stained.
5. Renz, 20 years old, Gravida 2 Para 1 (1001), Pregnancy Uterine 37
weeks and 4 days Age of Gestation, cephalic in beginning labor. 2020-031 01/27/2020 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM Clinical 0108299
Renz, 20 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 37 03:15 A.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
weeks and 4 days Age of Gestation, cephalic Normal Spontaneous 09094616941 09094616941
Delivery to an alive term Baby boy, Birth Weight 3100 grams, Premature
Rupture of Membrane x 2 hours.
NOTE: 1.) For Graduate Midwives: Supervision must be by qualified Faculty / Clinical Instructor.
2. Registered Midwives / Clinical Instructors who supervise the student midwives affix their signatures in this form must present a certificate of
Training of Perineal Lacerations to the Board pursuant to Board Resolution 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. ________________ issued at Polomolok, South Cotabato on _____________. CERTIFIED CORRECT:
Administering Officer or Notary Public Signature: ______________ Date: _______________
_______________________________ Printed Name: WILMA T. HERAMIL, MD
Designation: Principal/Chairman Health Services Education Unit
License No.: 0078733 Expiry Date: 11/17/2024