JULLIENNE LYING-IN

NAME: AND
ADRESS:
MATERNITY CLINIC
AGE: BLK36 LOT9 ZONE 11 AFP HOUSING,
BULIHAN, SILANG, CAVITE
BLOOD TYPE: CEL#: 09297149639
TETANUS TOXOID GIVEN
RODELIZA F. EMPIALES, RM
1 2 3 4 5 PRC LIC. #: 0126551

MARYCIL F. EMPIALES, RM
Number of previous pregnancy G____ P_____ PRC LIC. #: 0141176
_
PHILHEALTH
OBSTETRICAL HISTORY YES NO
3 Consecutive Miscarriage
ACCREDITED
Still Birth
Postpartum Hemorrhage Services offered:
NEW BORN SCREENING
PRESENT HEALTH YES NO
PROBLEM OB-GYNE clinic, Normal delivery by OB-
Tuberculosis GYNE, Pre-natal Check-up, Normal Delivery
Heart Disease by MIDWIFE, Immunization, Family
Diabetes Planning, Ear Piercing (HIKAW),
Asthma Nebulization, IUD insertion and removal,
Goiter Papsmer
Haemophilla

JULLIENNE LYING-IN
NAME:
ADRESS: AND
AGE:
MATERNITY CLINIC
BLK36 LOT9 ZONE 11 AFP HOUSING,
BLOOD TYPE: BULIHAN, SILANG, CAVITE
CEL#: 09297149639
TETANUS TOXOID GIVEN
1 2 3 4 5 RODELIZA F. EMPIALES, RM
PRC LIC. #: 0126551

MARYCIL F. EMPIALES, RM
Number of previous pregnancy G____ P_____ PRC LIC. #: 0141176
_

OBSTETRICAL HISTORY YES NO PHILHEALTH

3 Consecutive Miscarriage
Still Birth ACCREDITED
Postpartum Hemorrhage
Services offered:
PRESENT HEALTH YES NO
PROBLEM
NEW BORN SCREENING
Tuberculosis
OB-GYNE clinic, Normal delivery by OB-
Heart Disease
GYNE, Pre-natal Check-up, Normal Delivery
Diabetes by MIDWIFE, Immunization, Family
Asthma Planning, Ear Piercing (HIKAW),
Nebulization, IUD insertion and removal,
Papsmer
Goiter
haemohilla