PROFESSIONAL REGULATION ofCOMMISSION

Manila
BOARD OF MIDWIFERY
RECORD OF ACTUAL DELIVERIES HANDLED
Please Check if Applicant is:
Graduate Midwife Registered Nurse
Name of Applicant: TAVERA, CHERRY MAY School: SCHOLA DE SAN JOSE (Formerly: Provincial Technical Institute for Southern Mindanao)
Case Date and Full Name, Address of Facility & Check Supervised by:
Name and Complete Diagnosis (Gravida __ Para __) No. Time Contact Number if Home
Performed Deliver Printed Name & Position/ Signature License No./
y Contact No. Designation Exp. Date
1. Liencia 31, years old, Gravida 4 Para 4 (4004). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home
weeks and 1 day Age of Gestation, cephalic in labor, delivered Normal 2020-266 07/22/2020 Polomolok, South Cotabato EMELIA A. AMANTE, Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8-9, Birth 09:28 P.M 09094616941 RM, BCHS Instructor 11/17/2022
Weight 3000 grams. 09094616941
2. Menchie, 24 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home
weeks Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-268 07/23/2020 Polomolok, South Cotabato EMELIA A. AMANTE, Clinical 0108299
Delivery to a live Baby girl with an Apgar Score of 8-9, Birth Weight 2600 04:07 P.M. 09094616941 RM, BCHS Instructor 11/17/2022
grams. 09094616941
3.Aisa Glenn, 20 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 40 Emelia Ancuna- Amante Birthing Home
weeks Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-273 07/26/2020 Polomolok, South Cotabato EMELIA A. AMANTE, Clinical 0108299
Delivery to a live Baby girl with an Apgar Score of 8-9, Birth Weight 3200 12:24 A.M. 09094616941 RM, BCHS Instructor 11/17/2022
grams. 09094616941
4. Cheryll, 36 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home
weeks and 4 day Age of Gestation, cephalic in labor, delivered Normal 2020-275 07/27/2020 Polomolok, South Cotabato EMELIA A. AMANTE, Clinical 0108299
Spontaneous Delivery to a live Baby girl with an Apgar Score of 8-9, Birth 03:37 P.M. 09094616941 RM, BCHS Instructor 11/17/2022
Weight 3800 grams. 09094616941
5. Ma. Theresa, 23 years old, Gravida 3 Para 2 (3003). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
39 weeks And 5 days Age of Gestation, cephalic in labor, delivered Normal 2020-276 07/28/2020 Polomolok, South Cotabato EMELIA A. AMANTE, Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8-9, Birth 05:35 A.M. 09094616941 RM, BCHS Instructor 11/17/2022
Weight 2600 grams. 09094616941
6. Haney Jean, 25 years old, Gravida 4 Para 4 (4004). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
38 weeks Age of Gestation, cephalic in labor, delivered Normal 2020-277 07/30/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Spontaneous Delivery to a live Baby girl with an Apgar Score of 8-9, Birth 03:55 P.M. 09094616941 09094616941 Instructor 11/17/2022
Weight 3000 grams.
7. Erica, 25 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 40 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-279 07/31/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Delivery to a live Baby boy with an Apgar Score of 8-9, Birth Weight 2700 07:39 A.M. 09094616941 09094616941 Instructor 11/17/2022
grams.
8. Lina, 20 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 5 days Age of Gestation, cephalic in labor, delivered Normal 2020-281 08/01/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Spontaneous Delivery to a live Baby girl with an Apgar Score of 8-9, Birth 04:42 A.M. 09094616941 09094616941 Instructor 11/17/2022
Weight 2600 grams.
9. May Jane, 36 years old, Gravida 4 Para 4 (4004). Pregnancy Uterine 41 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 1 day Age of Gestation, cephalic in labor, delivered Normal 2020-282 08/02/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8-9, Birth 11:16 A.M. 09094616941 09094616941 Instructor 11/17/2022
Weight 3000 grams.
10. Kimberly Jane, 26 years old, Gravida 2 Para 2 (2002). Pregnancy Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
Uterine 39 weeks and 4 days Age of Gestation, cephalic in labor, delivered 2020-285 08/02/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Normal Spontaneous Delivery to a live Baby girl with an Apgar Score of 8- 04:03 A.M. 09094616941 09094616941 Instructor 11/17/2022
9, Birth Weight 2500 grams.

Case Date and Full Name, Address of Facility & Check Supervised by:
Name and Complete Diagnosis (Gravida __ Para __) No. Time Contact Number if Home
Performed Deliver Printed Name & Position/ Signature License No./
y Contact No. Designation Exp. Date
11. Manezya, 30 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-287 08/04/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Delivery to a live Baby girl with an Apgar Score of 8-9, Birth Weight 3100 06:00 P.M 09094616941 09094616941 Instructor 11/17/2022
grams.
12. Mary Rose, 26 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
39 weeks Age of Gestation, cephalic in labor, delivered Normal 2020-291 08/06/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8-9, Birth 05:40 P.M. 09094616941 09094616941 Instructor 11/17/2022
Weight 3100 grams.
13. Jennycil, 21 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 40 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 1 day Age of Gestation, cephalic in labor, delivered Normal 2020-292 08/07/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Spontaneous Delivery to a live Baby girl with an Apgar Score of 8-9, Birth 07:35 A.M. 09094616941 09094616941 Instructor 11/17/2022
Weight 2500 grams.
14. Genrose, 21 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks 5 days Age of Gestation, cephalic in labor, delivered Normal 2020-294 08/11/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Spontaneous Delivery to a live Baby girl with an Apgar Score of 8-9, Birth 08:10 A.M. 09094616941 09094616941 Instructor 11/17/2022
Weight 3000 grams.
15. Romelyn, 32 years old, Gravida 4 Para 4 (4004). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 4 days Age of Gestation, cephalic in labor, delivered Normal 2020-296 08/12/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8-9, Birth 01:03 P.M. 09094616941 09094616941 Instructor 11/17/2022
Weight 3300grams.
16. Sharon, 26 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 40 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 4 days Age of Gestation, cephalic in labor, delivered Normal 2020-297 08/13/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8-9, Birth 03:00 A.M. 09094616941 09094616941 Instructor 11/17/2022
Weight 3000 grams.
17. Emerlyn, 35 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-298 08/13/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Delivery to a live Baby girl with an Apgar Score of 8-9, Birth Weight 3200 02:27 A.M. 09094616941 09094616941 Instructor 11/17/2022
grams.
18. Jonalyn, 32 years old, Gravida 4 Para 4 (4004). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 1 day Age of Gestation, cephalic in labor, delivered Normal 2020-302 08/15/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Spontaneous Delivery to a live Baby girl with an Apgar Score of 8-9, Birth 08:26 A.M. 09094616941 09094616941 Instructor 11/17/2022
Weight 3300 grams.
19. Jill, 39 years old, Gravida 4 Para 4 (4004). Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 4 days Age of Gestation, cephalic in labor, delivered Normal 2020-303 08/16/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8-9, Birth 12:37 A.M. 09094616941 09094616941 Instructor 11/17/2022
Weight 2800 grams.
 20. Marilou , 34 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 1 day Age of Gestation, cephalic in labor, delivered Normal 2020-306 08/18/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Spontaneous Delivery to a live Baby girl with an Apgar Score of 8-9, Birth 01:09 A.M. 09094616941 09094616941 Instructor 11/17/2022
Weight 3400 grams.
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: TAVERA, CHERRY MAY School: SCHOLA DE SAN JOSE (Formerly: Provincial Technical Institute for Southern Mindanao)
Case Date and Full Name, Address of Facility & Check Supervised by:
Name and Complete Diagnosis (Gravida __ Para __) No. Time Contact Number if Home
Performed Deliver Printed Name & Position/ Signature License No./
y Contact No. Designation Exp. Date
1.Leincia, 31 years old, Gravida 4 Para 4 (4004). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 1 day Age of Gestation, cephalic in labor, 8cm dilated, 80% 2020-266 07/22/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
effaced, Intact Bag of Water, station +2 08:20 P.M 09094616941 09094616941 Instructor 11/17/2022
2. Menchie, 24 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks Age of Gestation, cephalic in labor, 8cm dilated, 80% effaced, Intact 2020-268 07/23/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Bag of Water, station 0. 03:00 P.M. 09094616941 09094616941 Instructor 11/17/2022
3. Aisa Glenn, 20 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
39 weeks and 4 day Age of Gestation, cephalic in labor, 7cm dilated, 80% 2020-273 07/26/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
effaced, Intact Bag of Water, station +2. 12:24 P.M. 09094616941 09094616941 Instructor 11/17/2022
4. Cheryll, 36 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 5 days Age of Gestation, cephalic in labor, 8cm dilated, 80% 2020-275 07/27/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
effaced, Intact Bag of Water, station +2. 02:20 P.M. 09094616941 09094616941 Instructor 11/17/2022
5. Ma. Theresa, 23 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
40 weeks Age of Gestation, cephalic in labor, 8cm dilated, 80% effaced, 2020-276 07/28/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Intact Bag of Water, station 0. 04p:30 A.M. 09094616941 09094616941 Instructor 11/17/2022
6. Haney Jean, 25 years old, Gravida 4 Para 4 (3012). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
38 weeks Age of Gestation, cephalic in labor, 8cm dilated,80% effaced, 2020-277 07/30/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Intact Bag of Water, station +2 2:49 P.M. 09094616941 09094616941 Instructor 11/17/2022
7. Erica, 27 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 40 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks Age of Gestation, cephalic in labor, 8cm dilated, 90% effaced, Intact 2020-279 07/31/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Bag of Water, station +2. 04:40 A.M. 09094616941 09094616941 Instructor 11/17/2022
8. Lina, 22 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 40 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 5 days Age of Gestation, cephalic in labor, 8cm dilated, 80% 2020-281 08/01/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
effaced, Intact Bag of Water, station +1. 03:40 A.M. 09094616941 09094616941 Instructor 11/17/2022
9. May Jane, 36 years old, Gravida 4 Para 4 (4004). Pregnancy Uterine 41 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 1 day Age of Gestation, cephalic in labor, 8cm dilated, 90% 2020-282 08/02/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
effaced, Intact Bag of Water, station +1. 09094616941 09094616941
 10:25 A.M. Instructor 11/17/2022
10. Kimberly Jane, 26 years old, Gravida 2 Para 2 (2002). Pregnancy Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
Uterine 39 weeks and 4 days Age of Gestation, cephalic in labor 8cm 2020-285 08/02/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
dilated, 80% effaced, Intact Bag of Water, station +2. 03:42 A.M. 09094616941 090946169 Instructor 11/17/2022
 Case Date and Full Name, Address of Facility & Check Supervised by:
Name and Complete Diagnosis (Gravida __ Para __) No. Time Contact Number if Home
Performed Deliver Printed Name & Position/ Signature License No./
y Contact No. Designation Exp. Date
11. Manezya, 30 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks Age of Gestation, cephalic in labor, 8cm dilated, 80% effaced, Intact 2020-287 08/04/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Bag of Water, station +1. 05:20 P.M 09094616941 0909461694 Instructor 11/17/2022
12. Mary Rose, 26 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
39 weeka Age of Gestation, cephalic in labor, 7cm dilated, 80% effaced, 2020-291 08/06/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Intact Bag of Water, station +1. 04:50 P.M. 09094616941 0909461694 Instructor 11/17/2022
13. Jennycil, 21 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 40 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 1 day Age of Gestation, cephalic in labor, 8cm dilated, 70% 2020-292 08/07/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
effaced, Intact Bag of Water, station +1. 06:55 A.M. 09094616941 0909461694 Instructor 11/17/2022
14. Genrose, 21 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 5 days Age of Gestation, cephalic in labor, 8cm dilated, 90% 2020-294 08/11/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
effaced, Intact Bag of Water, station +1. 07:50 A.M. 09094616941 0909461694 Instructor 11/17/2022
15. Romelyn, 32 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 4 days Age of Gestation, cephalic in labor, 8cm dilated, 90% 2020-296 08/12/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
effaced, Intact Bag of Water, station +2. 12:45 P.M. 09094616941 0909461694 Instructor 11/17/2022
16. Sharon, 26 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 40 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 4Bdays Age of Gestation, cephalic in labor, 8cm dilated, 80% 2020-297 08/13/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
effaced, Intact Bag of Water, station +2 2:35 A.M. 09094616941 0909461694 Instructor 11/17/2022
17. Emeryln, 35 years old, Gravida 3 Para 3 (3001). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks Age of Gestation, cephalic in labor 8cm dilated, 85% effaced, Intact 2020-298 08/13/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
Bag of Water, station +1 01:25 A.M. 09094616941 0909461694 Instructor 11/17/2022
18. Jonalyn, 32 years old, Gravida 4 Para 4 (4004). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 1 day Age of Gestation, cephalic in labor, 8cm dilated, 90% 2020-302 08/15/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
effaced, Intact Bag of Water, station +1 7:40 A.M. 09094616941 0909461694 Instructor 11/17/2022
19. Jill, 39 years old, Gravida 4 Para 4 (2002). Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 4 days Age of Gestation, cephalic in labor, 9cm dilated, 90% 2020-303 08/16/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
effaced, Intact Bag of Water, station +2 11:45 A.M. 09094616941 0909461694 Instructor 11/17/2022
20. Marilou, 34 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE,
weeks and 1 day Age of Gestation, cephalic in labor, 8cm dilated, 90% 2020-306 08/18/2020 Polomolok, South Cotabato RM, BCHS Clinical 0108299
effaced, Intact Bag of Water, station +1 12:40 A.M. 09094616941 0909461694 Instructor 11/17/2022
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: TAVERA,CHERRY MAY School: SCHOLA DE SAN JOSE (Formerly: Provincial Technical Institute for Southern Mindanao)
Case Date and Full Name, Address of Facility & Check Supervised by:
Name and Complete Diagnosis (Gravida __ Para __) No. Time Contact Number if Home
Performed Deliver Printed Name & Position/ Signature License No./
y Contact No. Designation Exp. Date
1. Menchie, 24 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 39 EMELIA A. AMANTE,
weeks Age of Gestation, cephalic presentation, delivered Normal Spontaneous 2020-268 07/23/2020 Emelia Ancuna- Amante Birthing Home RM, BCHS Clinical 0060909
Delivery to a live Baby boy at 04:07 P.M., with an Apgar Score of 8-9, Birth 04:07 P.M Polomolok, South Cotabato 0909461694 Instructor 3/19/2025
Weight 2600 grams. Placenta delivered at 04:10 PM, suture started 04:13 PM – 09094616941
suture ended 04:24 PM. Second Degree of perineal laceration repaired.
2. Cheryll, 36 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 39 weeks EMELIA A. AMANTE,
and 4 days Age of Gestation, cephalic presentation, delivered Normal 2020-275 07/27/2020 Emelia Ancuna- Amante Birthing Home RM, BCHS Clinical 0060909
Spontaneous Delivery to a live Baby girl at 03:37 P.M., with an Apgar Score of 03:37 P.M. Polomolok, South Cotabato 0909461694 Instructor 3/19/2025
8-9, Birth Weight 3800 grams. Placenta delivered at 03:40 PM, suture started 09094616941
03:43PM – suture ended 03:55 PM. First Degree of perineal laceration
repaired.
3. Ma. Theresa, 23 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 39 EMELIA A. AMANTE,
weeks and 5 days Age of Gestation, cephalic presentation, delivered Normal 2020-276 07/28/2020 Emelia Ancuna- Amante Birthing Home RM, BCHS Clinical 0060909
Spontaneous Delivery to a live Baby boy at 05:35 A.M., with an Apgar Score of 05:35 A.M. Polomolok, South Cotabato 0909461694 Instructor 3/19/2025
8-9, Birth Weight 2600 grams. Placenta delivered at 05:38 AM, suture started 09094616941
05:40 AM – suture ended 05:55AM. First Degree of perineal laceration
repaired.
4. May Jane, 36 years old, Gravida 4 Para 4 (4004). Pregnancy Uterine 41 EMELIA A. AMANTE,
weeks and 1day Age of Gestation, cephalic presentation, delivered Normal 2020-281 08/02/2020 Emelia Ancuna- Amante Birthing Home RM, BCHS Clinical 0060909
Spontaneous Delivery to a live Baby boy at 11:16 A.M., with an Apgar Score of 11:16 A.M. Polomolok, South Cotabato 0909461694 Instructor 3/19/2025
8-9, Birth Weight 3000 grams. Placenta delivered at 11:20 A.M, suture started 09094616941
11:23 AM – suture ended 11:38 PM. Second Degree of perineal laceration
repaired.
5. Kimberly Jeane, 26 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine EMELIA A. AMANTE,
39 weeks and 4 days Age of Gestation, cephalic presentation, delivered Normal 2020-285 08/02/2020 Emelia Ancuna- Amante Birthing Home RM, BCHS Clinical 0060909
Spontaneous Delivery to a live Baby girl at 04:03 P.M., with an Apgar Score of 04:03 P.M. Polomolok, South Cotabato 0909461694 Instructor 3/19/2025
8-9, Birth Weight 2500 grams. Placenta delivered at 04:07 PM, suture started 09094616941
04:09 PM – suture ended 04:21 PM. First Degree of perineal 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 _____________.
Mo_______________________________
Administering Officer or Notary Public
CERTIFIED CORRECT:
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: TAVERA, CHERRY MAY School: SCHOLA DE SAN JOSE (Formerly: Provincial Technical Institute for Southern Mindanao)
Case Date and Full Name, Address of Facility & Check Supervised by:
Name and Complete Diagnosis (Gravida __ Para __) No. Time Contact Number if Home
Performed Deliver Printed Name & Position/ Signature License No./
y Contact No. Designation Exp. Date
1. Elaine, 33 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39
weeks and 5 day Age of Gestation, cephalic in beginning labor. 21-545 12/21/2020 Heramil Hospital Shirley W. Bravo, RM Clinical 0110062
Elaine, 33 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 08:35 A.M Polomolok, South Cotabato 09468758483 Instructor 3/19/2025
weeks and 5 day Age of Gestation, cephalic Normal Spontaneous Delivery (083) 500-9247
to an alive term Baby boy, Birth Weight 3900 grams.
2. Claire,19 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39
weeks and 2 days Age of Gestation, cephalic in beginning labor. 21-011 01/18/2021 Heramil Hospital Shirley W. Bravo, RM Clinical 0110062
Claire, 19 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 07:15 A.M. Polomolok, South Cotabato 0946875848 Instructor 3/19/2025
weeks and 2 days Age of Gestation, cephalic Normal Spontaneous (083) 500-9247
Delivery to an alive term Baby boy, Birth Weight 2700 grams.
3. Mylene, 29 years old, Gravida 8 Para 8 (8008). Pregnancy Uterine 40
weeks Age of Gestation, cephalic in beginning labor. 21-023 02/03/2021 Heramil Hospital Shirley W. Bravo, RM Clinical 0110062
Mylene, 21 years old, Gravida 8 Para 8 (8008). Pregnancy Uterine 40 5:12 P.M. Polomolok, South Cotabato 0946875848 Instructor 3/19/2025
weeks Age of Gestation, cephalic Normal Spontaneous Delivery to an alive (083) 500-9247
term Baby boy, Birth Weight 2500 grams.
4. Angel, 21 years old, Gravida 2 Para 2 (2002) Pregnancy Uterine 39
weeks and 4 days Age of Gestation, cephalic in beginning labor. 21-033 02/13/2021 Heramil Hospital Shirley W. Bravo, RM Clinical 0110062
Angel, 21 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 12:07 P.M. Polomolok, South Cotabato 0946875848 Instructor 3/19/2025
weeks and 4 days Age of Gestation, cephalic Normal Spontaneous (083) 500-9247
Delivery to an alive term Baby girl, Birth Weight 2600 grams.
5. Cheryl, 34 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39
weeks and 1 day Age of Gestation, cephalic in beginning labor. 21-051 03/10/2021 Heramil Hospital Shirley W. Bravo, RM Clinical 0110062
Cheryl, 34 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 3:20 A.M. Polomolok, South Cotabato 0946875848 Instructor 3/19/2025
weeks and 1 day Age of Gestation, cephalic Normal Spontaneous Delivery (083) 500-9247
to an alive term Baby girl, Birth Weight 3500 grams.
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 _____________.
_______________________________
Administering Officer or Notary Public
CERTIFIED CORRECT:
Signature: ______________ Date: _______________
Printed Name: WILMA T. HERAMIL, MD
Designation: Principal/Chairman Health Services Education Unit
License No.: 0078733 Expiry Date: 11/17/2024