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 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. Rovelyn, 32 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 40 Emelia Ancuna- Amante Birthing Home
weeks and 1 day Age of Gestation, cephalic in labor, delivered Normal 2020-001 01/04/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Spontaneous Delivery to a live Baby girl with an Apgar Score of 8-9, Birth 12:59 A.M 09094616941 09293758345 Instructor 3/19/2025
Weight 3900 grams.
2. Jovelyn 40 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home
weeks Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-002 01/06/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Delivery to a live Baby boy with an Apgar Score of 8-9, Birth Weight 2600 03:20 A.M. 09094616941 09293758345 Instructor 3/19/2025
grams.
3. Alma, 32 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home
weeks and 2 day Age of Gestation, cephalic in labor, delivered Normal 2020-004 01/08/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8-9, Birth 03:30 P.M. 09094616941 09293758345 Instructor 3/19/2025
Weight 3080 grams.
4. Jenevie, 21 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 2020-007 01/11/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Delivery to a live Baby boy with an Apgar Score of 8-9, Birth Weight 3425 02:47 P.M. 09094616941 09293758345 Instructor 3/19/2025
grams.
5. Jessa Mae, 26 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
39 weeks and 4 day Age of Gestation, cephalic in labor, delivered Normal 2020-008 01/12/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Spontaneous Delivery to a live Baby girl with an Apgar Score of 8-9, Birth 09:26 A.M. 09094616941 09293758345 Instructor 3/19/2025
Weight 2745 grams.
6. Angeline, 24 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 41 Emelia Ancuna- Amante Birthing Home
weeks Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-009 01/12/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Delivery to a live Baby boy with an Apgar Score of 8-9, Birth Weight 2500 10:45 P.M. 09094616941 09293758345 Instructor 3/19/2025
grams.
7. Rovelyn, 26 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 2020-010 01/13/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Spontaneous Delivery to a live Baby girl with an Apgar Score of 8-9, Birth 07:24 P.M. 09094616941 09293758345 Instructor 3/19/2025
Weight 2675 grams.
8. Teresame, 31 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home
weeks and 1 day Age of Gestation, cephalic in labor, delivered Normal 2020-011 01/16/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8-9, Birth 12:45 A.M. 09094616941 09293758345 Instructor 3/19/2025
Weight 2515 grams.
9. Rosemary, 31 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 40 Emelia Ancuna- Amante Birthing Home
weeks Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-015 01/17/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Delivery to a live Baby boy with an Apgar Score of 8-9, Birth Weight 3075 05:00 A.M. 09094616941 09293758345 Instructor 3/19/2025
grams.
10. Nigel, 22 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home
weeks Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-017 01/18/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Delivery to a live Baby girl with an Apgar Score of 8-9, Birth Weight 2500 07:00 A.M. 09094616941 09293758345 Instructor 3/19/2025
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. Zita Grace, 38 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
40 weeks Age of Gestation, cephalic in labor, delivered Normal 2020-018 01/18/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8-9, Birth 02:27 P.M 09094616941 09293758345 Instructor 3/19/2025
Weight 3785 grams.
12. Ana Leah, 37 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 DAISY A. CRUZ, RM Clinical 0060909
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8-9, Birth 07:25 A.M. 09094616941 09293758345 Instructor 3/19/2025
Weight 3600 grams.
13. Catherine, 26 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
40 weeks and 4 day Age of Gestation, cephalic in labor, delivered Normal 2020-021 01/20/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Spontaneous Delivery to a live Baby girl with an Apgar Score of 8-9, Birth 10:35 P.M. 09094616941 09293758345 Instructor 3/19/2025
Weight 2685 grams.
14. Jecel, 26 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 DAISY A. CRUZ, RM Clinical 0060909
Spontaneous Delivery to a live Baby girl with an Apgar Score of 8-9, Birth 04:23 A.M. 09094616941 09293758345 Instructor 3/19/2025
Weight 3740 grams.
15. Queenjoy, 29 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 DAISY A. CRUZ, RM Clinical 0060909
Spontaneous Delivery to a live Baby girl with an Apgar Score of 8-9, Birth 06:00 A.M. 09094616941 09293758345 Instructor 3/19/2025
Weight 3225 grams.
16. Helen, 40 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 DAISY A. CRUZ, RM Clinical 0060909
Spontaneous Delivery to a live Baby girl with an Apgar Score of 8-9, Birth 10:55 P.M. 09094616941 09293758345 Instructor 3/19/2025
Weight 2800 grams.
17. Renz, 22 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 37 Emelia Ancuna- Amante Birthing Home
weeks and 4 day Age of Gestation, cephalic in labor, delivered Normal 2020-031 01/27/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8-9, Birth 05:25 A.M. 09094616941 09293758345 Instructor 3/19/2025
Weight 3150 grams.
18. Cheerry Mae, 29 years old, Gravida 2 Para 2 (2002). Pregnancy Emelia Ancuna- Amante Birthing Home
Uterine 40 weeks and 2 day Age of Gestation, cephalic in labor, delivered 2020-032 01/27/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Normal Spontaneous Delivery to a live Baby girl with an Apgar Score of 8- 04:45 A.M. 09094616941 09293758345 Instructor 3/19/2025
9, Birth Weight 2540 grams.
19. Jinjin, 25years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home
weeks Age of Gestation, cephalic in labor, delivered Normal Spontaneous 2020-038 02/09/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Delivery to a live Baby boy with an Apgar Score of 8-9, Birth Weight 2620 11:50 P.M. 09094616941 09293758345 Instructor 3/19/2025
grams.
20. Prechie, 25 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home
weeks and 2 days Age of Gestation, cephalic in labor, delivered Normal 2020-040 02/14/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8-9, Birth 03:45 P.M. 09094616941 09293758345 Instructor 3/19/2025
Weight 3135 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: 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 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. Rovelyn, 32 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 DAISY A. CRUZ, RM Clinical 0060909
effaced, Intact Bag of Water, station +2 12:28 A.M 09094616941 09293758345 Instructor 3/19/2025
2. Jovelyn 40 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 DAISY A. CRUZ, RM Clinical 0060909
Ruptured Bag of Water, station +3. 03:07 A.M. 09094616941 09293758345 Instructor 3/19/2025
3. Alma, 32 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home
weeks and 2 day Age of Gestation, cephalic in labor, 7cm dilated, 80% 2020-004 01/08/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
effaced, Intact Bag of Water, station +1. 01:40 P.M. 09094616941 09293758345 Instructor 3/19/2025
4. Jenevie, 21 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 DAISY A. CRUZ, RM Clinical 0060909
Ruptured Bag of Water, station +2. 02:33 P.M. 09094616941 09293758345 Instructor 3/19/2025
5. Jessa Mae, 26 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
39 weeks and 4 day Age of Gestation, cephalic in labor, 8cm dilated, 80% 2020-008 01/12/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
effaced, Intact Bag of Water, station 0. 07:20 A.M. 09094616941 09293758345 Instructor 3/19/2025
6. Angeline, 24 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine 41 Emelia Ancuna- Amante Birthing Home
weeks Age of Gestation, cephalic in labor, 10cm dilated,100% effaced, 2020-009 01/12/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Ruptured Bag of Water, station +4. 10:39 P.M. 09094616941 09293758345 Instructor 3/19/2025
7. Rovelyn, 26 years old, Gravida 3 Para 2 (2002). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing Home
weeks and 4 day Age of Gestation, cephalic in labor, 8cm dilated, 80% 2020-010 01/13/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
effaced, Intact Bag of Water, station +1. 06:40 P.M. 09094616941 09293758345 Instructor 3/19/2025
8. Teresame, 31 years old, Gravida 3 Para 2 (2002). Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home
weeks and 1 day Age of Gestation, cephalic in labor, 6cm dilated, 85% 2020-011 01/16/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
effaced, Intact Bag of Water, station +1. 09:50 P.M. 09094616941 09293758345 Instructor 3/19/2025
9. Rosemary, 31 years old, Gravida 3 Para 2 (2002). Pregnancy Uterine 40 Emelia Ancuna- Amante Birthing Home
weeks Age of Gestation, cephalic in labor, 8cm dilated, 90% effaced, Intact 2020-015 01/17/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
Bag of Water, station +1. 03:13 A.M. 09094616941 09293758345 Instructor 3/19/2025
10. Nigel, 22 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 DAISY A. CRUZ, RM Clinical 0060909
Intact Bag of Water, station +2. 06:42 A.M. 09094616941 09293758345 Instructor 3/19/2025
 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. Zita Grace, 38 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 DAISY A. CRUZ, RM Clinical 0060909
Intact Bag of Water, station +1. 01:20 P.M 09094616941 09293758345 Instructor 3/19/2025
12. Ana Leah, 37 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 DAISY A. CRUZ, RM Clinical 0060909
Intact Bag of Water, station +1. 05:40 A.M. 09094616941 09293758345 Instructor 3/19/2025
13. Catherine, 26 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine Emelia Ancuna- Amante Birthing Home
40 weeks and 4 day Age of Gestation, cephalic in labor, 8cm dilated, 90% 2020-021 01/20/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
effaced, Intact Bag of Water, station +1. 08:40 P.M. 09094616941 09293758345 Instructor 3/19/2025
14. Jecel, 26 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 DAISY A. CRUZ, RM Clinical 0060909
effaced, Intact Bag of Water, station +1. 02:30 A.M. 09094616941 09293758345 Instructor 3/19/2025
15. Queenjoy, 29 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 DAISY A. CRUZ, RM Clinical 0060909
Intact Bag of Water, station +2. 05:08 A.M. 09094616941 09293758345 Instructor 3/19/2025
16. Helen, 40 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 DAISY A. CRUZ, RM Clinical 0060909
effaced, Ruptured Bag of Water, station +3 10:37 P.M. 09094616941 09293758345 Instructor 3/19/2025
17. Renz, 22 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine 37 Emelia Ancuna- Amante Birthing Home
weeks and 4 day Age of Gestation, cephalic in labor 8cm dilated, 85% 2020-031 01/27/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
effaced, Intact Bag of Water, station +1 03:25 A.M. 09094616941 09293758345 Instructor 3/19/2025
18. Cheerry Mae, 29 years old, Gravida 2 Para 1 (1001). Pregnancy Emelia Ancuna- Amante Birthing Home
Uterine 40 weeks and 2 day Age of Gestation, cephalic in labor, 9cm 2020-032 01/27/2020 Polomolok, South Cotabato DAISY A. CRUZ, RM Clinical 0060909
dilated, 90% effaced, Ruptured Bag of Water, station +2 03:40 P.M. 09094616941 09293758345 Instructor 3/19/2025
19. Jinjin, 25years 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 DAISY A. CRUZ, RM Clinical 0060909
Ruptured Bag of Water, station +4 11:45 P.M. 09094616941 09293758345 Instructor 3/19/2025
20. Prechie, 25 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 DAISY A. CRUZ, RM Clinical 0060909
effaced, Intact Bag of Water, station +1 01:40 P.M. 09094616941 09293758345 Instructor 3/19/2025
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 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. Rovelyn, 32 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 DAISY A. CRUZ, RM Clinical 0060909
Spontaneous Delivery to a live Baby girl at 12:59 A.M., with an Apgar Score of 01:27 A.M Polomolok, South Cotabato 09293758345 Instructor 3/19/2025
8-9, Birth Weight 3900 grams. Placenta delivered at 01:08 AM, suture started 09094616941
01:13AM – suture ended 01:27 AM. Second Degree of perineal laceration
repaired.
2. Jenevie, 21 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 40 weeks
Age of Gestation, cephalic presentation, delivered Normal Spontaneous 2020-007 01/11/2020 Emelia Ancuna- Amante Birthing Home DAISY A. CRUZ, RM Clinical 0060909
Delivery to a live Baby boy at 02:47 P.M., with an Apgar Score of 8-9, Birth 03:06 P.M. Polomolok, South Cotabato 09293758345 Instructor 3/19/2025
Weight 3425 grams. Placenta delivered at 02:55 PM, suture started 02:57 PM – 09094616941
suture ended 03:06 PM. First Degree of perineal laceration repaired.
3. Zita Grace, 38 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 40
weeks Age of Gestation, cephalic presentation, delivered Normal Spontaneous 2020-018 01/18/2020 Emelia Ancuna- Amante Birthing Home DAISY A. CRUZ, RM Clinical 0060909
Delivery to a live Baby girl at 02:27 P.M., with an Apgar Score of 8-9, Birth 02:53 P.M. Polomolok, South Cotabato 09293758345 Instructor 3/19/2025
Weight 3785 grams. Placenta delivered at 02:39 PM, suture started 02:43 PM – 09094616941
suture ended 02:53 PM. First Degree of perineal laceration repaired.
4. Jecel, 26 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 DAISY A. CRUZ, RM Clinical 0060909
Spontaneous Delivery to a live Baby girl at 04:23 A.M., with an Apgar Score of 04:46 A.M. Polomolok, South Cotabato 09293758345 Instructor 3/19/2025
8-9, Birth Weight 3740 grams. Placenta delivered at 04:29 AM, suture started 09094616941
04:32 AM – suture ended 04:46 AM. Second Degree of perineal laceration
repaired.
5. Prechie, 25 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 DAISY A. CRUZ, RM Clinical 0060909
Spontaneous Delivery to a live Baby boy at 03:45 P.M., with an Apgar Score of 03:56 P.M. Polomolok, South Cotabato 09293758345 Instructor 3/19/2025
8-9, Birth Weight 3135 grams. Placenta delivered at 03:53 PM, suture started 09094616941
03:56 PM – suture ended 04:06 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 _____________.

_______________________________ 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 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. Alma, 32 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 DAISY A. CRUZ, RM Clinical 0060909
Alma, 32 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 38 01:30 P.M Polomolok, South Cotabato 09293758345 Instructor 3/19/2025
weeks and 2 days Age of Gestation, cephalic Normal Spontaneous 09094616941
Delivery to an alive term Baby boy, Birth Weight 3080 grams.
2. Jessa Mae, 26 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 DAISY A. CRUZ, RM Clinical 0060909
Jessa Mae, 26 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 07:15 A.M. Polomolok, South Cotabato 09293758345 Instructor 3/19/2025
39 weeks and 4 days Age of Gestation, cephalic Normal Spontaneous 09094616941
Delivery to an alive term Baby girl, Birth Weight 2745 grams.
3. Teresame, 31 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 DAISY A. CRUZ, RM Clinical 0060909
Teresame, 31 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 38 09:40 P.M. Polomolok, South Cotabato 09293758345 Instructor 3/19/2025
weeks and 1 days Age of Gestation, cephalic Normal Spontaneous 09094616941
Delivery to an alive term Baby boy, Birth Weight 2515 grams.
4. Catherine, 26 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 DAISY A. CRUZ, RM Clinical 0060909
Catherine, 26 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 40 08:30 P.M. Polomolok, South Cotabato 09293758345 Instructor 3/19/2025
weeks and 4 days Age of Gestation, cephalic Normal Spontaneous 09094616941
Delivery to an alive term Baby girl, Birth Weight 2685 grams.
5. Renz, 22 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 DAISY A. CRUZ, RM Clinical 0060909
Renz, 22 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 37 03:15 A.M. Polomolok, South Cotabato 09293758345 Instructor 3/19/2025
weeks and 4 days Age of Gestation, cephalic Normal Spontaneous 09094616941
Delivery to an alive term Baby boy, Birth Weight 3150 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
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_______________________________ CERTIFIED CORRECT:

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Signature: ______________ Date: _______________
Printed Name: WILMA T. HERAMIL, MD
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