PROFESSIONAL REGULATION COMMISSION

Manila
BOARD OF MIDWIFERY
RECORD OF ACTUAL DELIVERIES HANDLED
Please Check if Applicant is:
√ Graduate Midwife Registered Nurse

Name of Applicant: COTMAYA, JUDITH NARVAZA School: SCHOLA DE SAN JOSE, INC (Formerly: Provincial Technical Institute for Southern Mindanao)

Case Date & Time Full Name, Address of Check Supervised by:
Name and Compplete Diagnosis (Gravida __ Para __ ) No. Performed Facility & Contact if Home Printed Name & Position/ License No./
Signature
Number Delivery Contact No. Designation Exp. Date
1.Mirasol, 32 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 38 weeks Heramil Hospital
and 2 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-464 10/29/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Boy with an Apgar Score of 9, Birth Weight 3300 grams. 10:25 A.M (083) 500-9247 09468758483 Instructor 2/5/2023
2.Mica, 20 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 weeks Heramil Hospital
and 5 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-496 11/20/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Boy with an Apgar Score of 8, Birth Weight 3200 grams. 7:45 P.M (083) 500-9247 09468758483 Instructor 2/5/2023
3.Jenelyn, 32 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 weeks Heramil Hospital
and 3 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-498 11/22/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Girl with an Apgar Score of 9, Birth Weight 3400 grams. 1:25 P.M (083) 500-9247 09468758483 Instructor 2/5/2023
4.Crystyll Joy, 24 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 40 weeks Heramil Hospital
and 5 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-500 11/23/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Boy with an Apgar Score of 8, Birth Weight 3400 grams. 9:00 A.M (083) 500-9247 09468758483 Instructor 2/5/2023
5.Angelyn, 26 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 weeks Heramil Hospital
and 6 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-502 11/23/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Girl with an Apgar Score of 8, Birth Weight 3300 grams. 1:10 P.M (083) 500-9247 09468758483 Instructor 2/5/2023
6.Flordeliza, 22 years old, Gravida 3 Para 2 (2012). Pregnancy Uterine 37 weeks Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
and 4 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-533 12/22/2020 Polomolok South Cotabato BCHS Clinical 0108299
Delivery to a live Baby Girl with an Apgar Score of 9, Birth Weight 2700 grams. 7:49 A.M 09094616941 09094616941 Instructor 11/17/2022
7.Rizalyn, 24 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 weeks Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
and 1 day Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-535 12/25/2020 Polomolok South Cotabato BCHS Clinical 0108299
Delivery to a live Baby Girl with an Apgar Score of 8, Birth Weight 2600 grams. 8:11 A.M 09094616941 09094616941 Instructor 11/17/2022
8.Bernadeth, 22 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 weeks Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
and 1 day Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-540 12/27/2020 Polomolok South Cotabato BCHS Clinical 0108299
Delivery to a live Baby Girl with an Apgar Score of 9, Birth Weight 3200 grams. 6:50 A.M 09094616941 09094616941 Instructor 11/17/2022
9.Jessa Mae, 30 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 39 weeks Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
and 5 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-542 12/27/2020 Polomolok South Cotabato BCHS Clinical 0108299
Delivery to a live Baby Girl with an Apgar Score of 9, Birth Weight 3300 grams. 08:18 P.M 09094616941 09094616941 Instructor 11/17/2022
10.Rosean, 25 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 37 weeks Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
and 4 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-543 12/28/2020 Polomolok South Cotabato BCHS Clinical 0108299
Delivery to a live Baby Girl with an Apgar Score of 9, Birth Weight 3300 grams. 10:48 A.M 09094616941 09094616941 Instructor 11/17/2022
 Case Date & Time Full Name, Address of Check Supervised by:
Name and Compplete Diagnosis (Gravida __ Para __ ) No. Performed Facility & Contact if Home Printed Name & Position/
Signature
Number Delivery Contact No. Designation
11.Monavi, 36 years old Gravida 3 Para 3 (3003). Pregnancy Uterine 40 weeks Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
Age of Gestation, cephalic in labor, delivered Normal Spontaneous Delivery 2020-544 12/29/2020 Polomolok South Cotabato BCHS Clinical
to a live Baby Girl with an Apgar Score of 9, Birth Weight 3200 grams. 11:56 A.M 09094616941 09094616941 Instructor
12.Geraldine, 33 years old Gravida 4 Para 4 (4004). Pregnancy Uterine 38 weeks Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
and 4 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2021-004 1/4/2021 Polomolok South Cotabato BCHS Clinical
Delivery to a live Baby Girl with an Apgar Score of 9, Birth Weight 3600 grams. 07:38 A.M 09094616941 09094616941 Instructor
13.Alyssa Mae, 22 years old Gravida 2 Para 2 (2002). Pregnancy Uterine 38 weeks Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
Age of Gestation, cephalic in labor, delivered Normal Spontaneous Delivery 2021-006 1/5/2021 Polomolok South Cotabato BCHS Clinical
to a live Baby Boy with an Apgar Score of 8, Birth Weight 2900 grams. 01:10 P.M 09094616941 09094616941 Instructor
14.Jocyl, 31 years old Gravida 3 Para 3 (3003). Pregnancy Uterine 37 weeks Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
and 5 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2021-007 1/5/2021 Polomolok South Cotabato BCHS Clinical
Delivery to a live Baby Girl with an Apgar Score of 8, Birth Weight 2900 grams. 07:20 A.M 09094616941 09094616941 Instructor
15.Honey May, 28 years old Gravida 2 Para 2 (2002). Pregnancy Uterine 39 weeks Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
and 1 day Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2021-012 1/7/2021 Polomolok South Cotabato BCHS Clinical
Delivery to a live Baby Boy with an Apgar Score of 9, Birth Weight 3300 grams. 02:22 P.M 09094616941 09094616941 Instructor
16.Jamaica Kristia, 28 years old Gravida 3 Para 2 (2012). Pregnancy Uterine 39 Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
weeks Age of Gestation, cephalic in labor, delivered Normal Spontaneous Delivery 2021-032 1/21/2021 Polomolok South Cotabato BCHS Clinical
Delivery to a live Baby Girl with an Apgar Score of 8, Birth Weight 3300 grams. 03:25 P.M 09094616941 09094616941 Instructor
17.Bulak, 33 years old Gravida 4 Para 4 (4004). Pregnancy Uterine 39 weeks Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
and 5 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2021-033 1/22/2021 Polomolok South Cotabato BCHS Clinical
Delivery to a live Baby Girl with an Apgar Score of 9, Birth Weight 3500 grams. 01:15 A.M 09094616941 09094616941 Instructor
18.Elvie, 28 years old Gravida 2 Para 2 (2002). Pregnancy Uterine 39 weeks Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
and 5 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2021-035 1/23/2021 Polomolok South Cotabato BCHS Clinical
Delivery to a live Baby Girl with an Apgar Score of 8, Birth Weight 2900 grams. 12:10 A.M 09094616941 09094616941 Instructor
19.Ruby Jane, 21 years old Gravida 3 Para 3 (3003). Pregnancy Uterine 39 weeks Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
and 1 day Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2021-036 1/24/2021 Polomolok South Cotabato BCHS Clinical
Delivery to a live Baby Boy with an Apgar Score of 9, Birth Weight 3100 grams. 04:40 P.M 09094616941 09094616941 Instructor
20.Judith, 28 years old Gravida 3 Para 3 (3003). Pregnancy Uterine 39 weeks Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
and 4 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2021-042 1/29/2021 Polomolok South Cotabato BCHS Clinical
Delivery to a live Baby Girl with an Apgar Score of 8, Birth Weight 3300 grams. 03:25 P.M 09094616941 09094616941 Instructor
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 _____________.
CERTIFIED CORRECT:
______________________________ Affix
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
 License No./
Exp. Date

0108299
11/17/2022

0108299
11/17/2022

0108299
11/17/2022

0108299
11/17/2022

0108299
11/17/2022

0108299
11/17/2022

0108299
11/17/2022

0108299
11/17/2022

0108299
11/17/2022

0108299
11/17/2022

ation Unit
 PROFESSIONAL REGULATION COMMISSION
Manila
BOARD OF MIDWIFERY
RECORD OF ACTUAL INTERNAL EXAMINATION
Please Check if Applicant is:

√ Graduate Midwife Registered Nurse

Name of Applicant: COTMAYA, JUDITH NARVAZA School: SCHOLA DE SAN JOSE, INC. (Formerly: Provincial Technical Institute for Southern Mindanao)
Case Date & Time Full Name, Address of Check Supervised by:
Name and Compplete Diagnosis (Gravida __ Para __ ) No. Performed Facility & Contact if Home Printed Name & Position/ License No./
Signature
Name Delivery Contact No. Designation Exp. Date
1.Mirasol, 32 years old, Gravida 3 Para 2 (3002). Pregnancy Uterine 38 weeks and Heramil Hospital
2 days Age of Gestation, cephalic in labor, 8 cm dilated, 80 % effaced, Intact Bag 2020-464 10/29/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
of Water station +1. 8:45 A.M (083) 500-9247 09468758483 Instructor 2/5/2023
2.Mica, 20 years old, Gravida 2 Para 1 (2001). Pregnancy Uterine 39 weeks and Heramil Hospital
5 days Age of Gestation, cephalic in labor, 8 cm dilated, 80 % effaced, Ruptured Bag 2020-496 11/20/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
of Water, amniotic fluid clear station +1. 5:38 P.M (083) 500-9247 09468758483 Instructor 2/5/2023
3.Jenelyn, 32 years old, Gravida 2 Para 1 (2001). Pregnancy Uterine 39 weeks and Heramil Hospital
3 days Age of Gestation, cephalic in labor, 8 cm dilated, 80 % effaced, Intact Bag 2020-498 11/22/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
of Water station +1. 11:45 A.M (083) 500-9247 09468758483 Instructor 2/5/2023
4.Crystyll Joy, 24 years old, Gravida 1 Para 0. Pregnancy Uterine 40 weeks and Heramil Hospital
5 days Age of Gestation, cephalic in labor, 8 cm dilated, 80 % effaced, Ruptured Bag 2020-500 11/23/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
of Water, amniotic fluid clear station +1. 7:10 A.M (083) 500-9247 09468758483 Instructor 2/5/2023
5.Angelyn, 26 years old, Gravida 1 Para 0 . Pregnancy Uterine 39 weeks and Heramil Hospital
6 days Age of Gestation, cephalic in labor, 10 cm dilated, 100 % effaced, Ruptured Bag 2020-502 11/23/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
of Water, amniotic fluid clear station +4. 12:57 P.M (083) 500-9247 09468758483 Instructor 2/5/2023
6.Flordeliza, 22 years old, Gravida 3 Para 1 (2011). Pregnancy Uterine 37 weeks and Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
4 days Age of Gestation, cephalic in labor, 9 cm dilated, 90 % effaced, Intact Bag 2020-533 12/20/2020 Polomolok South Cotabato BCHS Clinical 0108299
of Water station +2. 6:50 A.M 09094616941 09094616941 Instructor 11/17/2022
7.Rizalyn, 24 years old, Gravida 2 Para 1 (2001). Pregnancy Uterine 39 weeks and Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
1 day Age of Gestation, cephalic in labor, 7 cm dilated, 70 % effaced, Intact Bag 2020-535 12/25/2020 Polomolok South Cotabato BCHS Clinical 0108299
of Water, station 0. 5:10 A.M 09094616941 09094616941 Instructor 11/17/2022
8.Bernadeth, 22 years old, Gravida 2 Para 1 (2001). Pregnancy Uterine 39 weeks and Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
1 day Age of Gestation, cephalic in labor, 8 cm dilated, 80 % effaced, Intact Bag 2020-540 12/27/2020 Polomolok South Cotabato BCHS Clinical 0108299
of Water, station +2. 5:00 A.M 09094616941 09094616941 Instructor 11/17/2022
9.Jessa Mae, 30 years old, Gravida 3 Para 2 (3002). Pregnancy Uterine 39 weeks and Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
5 days Age of Gestation, cephalic in labor, 9 cm dilated, 90 % effaced, Intact Bag 2020-542 12/27/2020 Polomolok South Cotabato BCHS Clinical 0108299
of Water station +2. 7:25 P.M 09094616941 09094616941 Instructor 11/17/2022
10.Rosean, 25 years old, Gravida 2 Para 1 (2001). Pregnancy Uterine 37 weeks and Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
4 days Age of Gestation, cephalic in labor, 10 cm dilated, 100 % effaced, Intact Bag 2020-543 12/29/2020 Polomolok South Cotabato BCHS Clinical 0108299
of Water station +3. 10:23 A.M 09094616941 09094616941 Instructor 11/17/2022
 Case Date & Time Full Name, Address of Check Supervised by:
Name and Compplete Diagnosis (Gravida __ Para __ ) No. Performed Facility & Contact if Home Printed Name & Position/
Signature
Number Delivery Contact No. Designation
11.Monavi, 36 years old, Gravida 3 Para 2 (3002). Pregnancy Uterine 40 weeks and Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
Age of Gestation, cephalic in labor, 10 cm dilated, 100 % effaced, Intact Bag 2020-544 12/29/2020 Polomolok South Cotabato BCHS Clinical
of Water station +3. 11:40 A.M 09094616941 09094616941 Instructor
12.Geraldine, 33 years old, Gravida 4 Para 3 (4003). Pregnancy Uterine 38 weeks and Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
4 days Age of Gestation, cephalic in labor, 9 cm dilated, 90 % effaced, Intact Bag 2021-004 1/4/2021 Polomolok South Cotabato BCHS Clinical
of Water, station +2. 6:32 A.M 09094616941 09094616941 Instructor
13.Alyssa Mae, 22 years old, Gravida 2 Para 1 (2001). Pregnancy Uterine 38 weeks and Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
Age of Gestation, cephalic in labor, 8 cm dilated, 80 % effaced, Intact Bag of Water 2021-006 1/5/2021 Polomolok South Cotabato BCHS Clinical
station +1. 12:30 P.M 09094616941 09094616941 Instructor
14.Jocyl, 31 years old, Gravida 3 Para 2 (3002). Pregnancy Uterine 37 weeks and Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
5 days Age of Gestation, cephalic in labor, 9 cm dilated, 90 % effaced, Intact Bag 2021-007 1/5/2021 Polomolok South Cotabato BCHS Clinical
of Water station +2. 6:25 A.M 09094616941 09094616941 Instructor
15.Honey May, 28 years old, Gravida 2 Para 1 (2001). Pregnancy Uterine 39 weeks and Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
1 day Age of Gestation, cephalic in labor, 9 cm dilated, 90 % effaced, Intact Bag 2021-012 1/7/2021 Polomolok South Cotabato BCHS Clinical
of Water station +2. 01:30 P.M 09094616941 09094616941 Instructor
16.Jamaica Kristia, 22 years old, Gravida 3 Para 1 (2011). Pregnancy Uterine 39 weeks Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
Age of Gestation, cephalic in labor, 9 cm dilated, 90 % effaced, Intact Bag of Water 2021-032 1/21/2021 Polomolok South Cotabato BCHS Clinical
station +2. 02:25 P.M 09094616941 09094616941 Instructor
17.Bulak, 33 years old, Gravida 4 Para 3 (4003). Pregnancy Uterine 39 weeks and Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
5 days Age of Gestation, cephalic in labor, 8 cm dilated, 80 % effaced, Intact Bag 2021-033 1/21/2021 Polomolok South Cotabato BCHS Clinical
of Water, station +1. 11:20 A.M 09094616941 09094616941 Instructor
18.Elvie, 28 years old, Gravida 2 Para 1 (2001). Pregnancy Uterine 39 weeks and Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
5 days Age of Gestation, cephalic in labor, 8 cm dilated, 80 % effaced, Intact Bag 2021-035 1/22/2021 Polomolok South Cotabato BCHS Clinical
of Water station +1. 10:10 P.M 09094616941 09094616941 Instructor
19.Ruby Jane, 21 years old, Gravida 3 Para 2 (3002). Pregnancy Uterine 39 weeks and Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
1 day Age of Gestation, cephalic in labor, 7 cm dilated, 70 % effaced, Intact Bag 2021-036 1/24/2021 Polomolok South Cotabato BCHS Clinical
of Water, station 0. 2:05 P.M 09094616941 09094616941 Instructor
20.Judith, 28 years old, Gravida 3 Para 2 (3002). Pregnancy Uterine 39 weeks and Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM.
4 days Age of Gestation, cephalic in labor, 9 cm dilated, 90 % effaced, Intact Bag 2021-042 1/29/2021 Polomolok South Cotabato BCHS Clinical
of Water station +2. 02:10 P.M 09094616941 09094616941 Instructor

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 _____________.

______________________________
Administering Officer or Notary Public
CERTIFIED CORRECT:
Affix
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
License No./
Exp. Date

0108299
11/17/2022

0108299
11/17/2022

0108299
11/17/2022

0108299
11/17/2022

0108299
11/17/2022

0108299
11/17/2022

0108299
11/17/2022

0108299
11/17/2022

0108299
11/17/2022

0108299
11/17/2022
cation Unit
 PROFESSIONAL REGULATION COMMISSION
Manila
BOARD OF MIDWIFERY
RECORD OF ACTUAL INTRAVENOUS INSERTION
Please Check if Applicant is:

√ Graduate Midwife Registered Nurse

Name of Applicant: COTMAYA, JUDITH NARVAZA School: SCHOLA DE SAN JOSE, INC. (Formerly: Provincial Technical Institute for Southern Mindanao)

Date & Time Full Name, Address of Check Supervised by:

Name and Compplete Diagnosis (Gravida __ Para __ ) Case No. Performed Facility & Contact Number if Home Printed Name & Position/ License No./
Signature
Delivery Contact No. Designation Exp. Date
1.Mirasol, 32 years old, Gravida 3 Para 2 (3002). Pregnancy Uterine 38 weeks and 2 days Age of
Gestation, cephalic beginning labor. Heramil Hospital SHIRLEY W. BRAVO, RM
Mirasol, 32 years old Gravida 3 Para 3 (3003). Pregnancy Uterine 38 weeks and 2 days Age 2020-464 10/29/2020 Polomolok South Cotabato 09468758483 Clinical 0110062
of Gestation Normal Spontaneous delivery to alive full term Baby Boy, Birth Weight 8:35 A.M (083) 500-9247 Instructor 2/5/2023
3300 grams Premature Rupture of Membrane x 3hours.
2.Mica, 20 years old, Gravida 2 Para 1 (2001). Pregnancy Uterine 39 weeks and 5 days Age of
Gestation, cephalic beginning labor. Heramil Hospital SHIRLEY W. BRAVO, RM
Mica, 20 years old Gravida 2 Para 2 (2002). Pregnancy Uterine 39 weeks and 5 days Age 2020-496 11/20/2020 Polomolok South Cotabato 09468758483 Clinical 0110062
of Gestation normal spontaneous delivery to an alive full term Baby Boy, Birth Weight 5:28 P.M (083) 500-9247 Instructor 2/5/2023
3200 grams Premature Rupture of Membrane x 2 hours.
3.Jenelyn, 32 years old, Gravida 2 Para 1 (2001). Pregnancy Uterine 39 weeks and 3 days Age of
Gestation, cephalic beginning labor. Heramil Hospital SHIRLEY W. BRAVO, RM
Jenelyn, 32 years old Gravida 2 Para 2 (2002). Pregnancy Uterine 39 weeks and 3 days Age 2020-498 11/22/2020 Polomolok South Cotabato 09468758483 Clinical 0110062
of Gestation normal spontaneous delivery to an alive full term Baby Girl, Birth Weight 11:35 A.M (083) 500-9247 Instructor 2/5/2023
3400 grams Premature Rupture of Membrane × 2 hours.
4.Crystyll Joy, 24 years old, Gravida 1 Para 0 (1000). Pregnancy Uterine 40 weeks and 5 days Age of
Gestation, cephalic beginning labor. Heramil Hospital SHIRLEY W. BRAVO, RM
Crystyll Joy, 24 years old Gravida 1 Para 0 (1001). Pregnancy Uterine 40 weeks and 5 days Age 2020-500 11/23/2020 Polomolok South Cotabato 09468758483 Clinical 0110062
of Gestation normal spontaneous delivery to an alive full term Baby Boy, Birth Weight 7:00 A.M (083) 500-9247 Instructor 2/5/2023
3400 grams Premature Rupture of Membrane x 2 hours.
5.Angelyn, 26 years old, Gravida 1 Para 0 (1000). Pregnancy Uterine 39 weeks and 6 days Age of
Gestation, cephalic beginning labor. Heramil Hospital SHIRLEY W. BRAVO, RM
Angelyn, 26 years old Gravida 1 Para 0 (1001). Pregnancy Uterine 39 weeks and 6 days Age 2020-502 11/23/2020 Polomolok South Cotabato 09468758483 Clinical 0110062
of Gestation normal spontaneous delivery to an alive full term Baby Girl, Birth Weight 12:47 P.M (083) 500-9247 Instructor 2/5/2023
3300 grams Premature Rupture of Membrane x 3hour.

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 CERTIFIED CORRECT:
Training of Suturing of Perineal Lacerations to the Board pursuant to Board Resolution No. 100, Series of 1993, dated December 1, 1993.
Signature: ______________ Date: _______________
SUBSCRIBED AND SWORN TO before me this ___________________ at ____________________ Affiant exhibiting to me his/her Residence Printed Name: WILMA T. HERAMIL, MD
Certificate No. issued at Polomolok, South Cotabato on _____________. Designation: Principal/Chairman Health Services Education Unit
______________________________ License No.: 0078733 Expiry Date: 11/17/2024
Administering Officer or Notary Public
 PROFESSIONAL REGULATION COMMISSION
Manila
BOARD OF MIDWIFERY
RECORD OF ACTUAL SUTURING OF PERINEAL LACERATIONS

Please Check if Applicant is:

√ Graduate Midwife Registered Nurse

School: SCHOLA DE SAN JOSE (Formerly: Provincial Technical Institute for Southern Mindanao)
Name of Applicant: COTMAYA, JUDITH NARVAZA
Case Date & Time Full Name, Address of Check Supervised by:
Name and Compplete Diagnosis (Gravida __ Para __ ) No. Performed Facility & Contact if Home Printed Name & Position/
Signature
Number Delivery Contact No. Designation
1.Bernadeth, 22 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 weeks and 1 day Age of
Gestation, cephalic presentation, delivered Normal Spontaneous Delivery to a live full term Baby Girl 12/27/2020 Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM. Clinical
at 6:50 A.M with an Apgar Score of 9 Birth Weight 3200 grams. Placenta delivery at 6:55 A.M suture 2020-540 6:50 A.M Polomolok South Cotabato BCHS Instructor
started 6:58 A.M — suture ended 7:18 A.M First degree of perineal laceration repaired. 09094616941 09094616941
2.Monavi, 36 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 40 weeks Age of Gestation
cephalic presentation, delivered Normal Spontaneous Delivery to a live full term Baby Girl at 11:56 A.M 12/29/2020 Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM. Clinical
with an Apgar Score of 9 Birth Weight 3200 grams. Placenta delivery at 12:01 P.M suture started 2020-544 12:04 P.M Polomolok South Cotabato BCHS Instructor
started 12:04 P.M — suture ended 12:24 P.M First degree of perineal laceration repaired. 09094616941 09094616941
3.Jenelyn, 32 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 weeks and 3 days Age of
Gestation, cephalic presentation, delivered Normal Spontaneous Delivery to a live full term Baby Girl 11/22/2020 Heramil Hospital SHIRLEY W. BRAVO, RM Clinical
at 1:25 P.M with an Apgar Score of 9 Birth Weight 3400 grams. Placenta delivery at 1:30 P.M suture 2020-498 1:33 P.M Polomolok South Cotabato 09468758483 Instructor
started 1:33 P.M — suture ended 1:53 P.M First degree of perineal laceration repaired. (083) 500-9247
4.Crystyll Joy, 24 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 40 weeks and 5 days Age of
Gestation, cephalic presentation, delivered Normal Spontaneous Delivery to a live full term Baby Boy 11/23/2020 Heramil Hospital SHIRLEY W. BRAVO, RM Clinical
at 9:00 A.M with an Apgar Score of 9 Birth Weight 3400 grams. Placenta delivery at 9:05 A.M suture 2020-500 9:08 A.M Polomolok South Cotabato 09468758483 Instructor

started 9:08 A.M — suture ended 9:28 A.M First degree of perineal laceration repaired. (083) 500-9247
5.Honey May, 28 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 weeks and 1 day Age of
Gestation, cephalic presentation, delivered Normal Spontaneous Delivery to a live full term Baby Boy 1/7/2021 Emelia Ancuna-Amante Birthing Home EMELIA A. AMANTE RM. Clinical
at 2:22 P.M with an Apgar Score of 8 Birth Weight 3300 grams. Placenta delivery at 02:27 P.M suture 2021-012 2:30 P.M Polomolok South Cotabato BCHS Instructor

started 2:30 P.M — suture ended 2:50 P.M First degree of perineal laceration repaired. 09094616941 09094616941
SUBSCRIBED AND SWORN TO before me this ___________________ at ____________________ Affiant exhibiting to me his/her Residence CERTIFIED CORRECT:
Certificate No. issued at Polomolok, South Cotabato on _____________.
Signature: ______________ Date: _______________
_______________________________ Printed Name: WILMA T. HERAMIL, MD
Administering Officer or Notary Public Designation: Principal/Chairman Health Services Education Unit
License No.: 0078733 Expiry Date: 11/17/2024
anao)

License No./
Exp. Date

0108299
11/17/2022

0108299
11/17/2022

0110062
2/5/2023

0110062
2/5/2023

0108299
11/17/2022
ducation Unit