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Sibala’s lying-in

NAME:
ADRESS: clinic
BLK36 LOT9 ZONE 11 AFP HOUSING,
BULIHAN, SILANG, CAVITE
AGE: CEL#: 09297149639
BLOOD TYPE:
RODELIZA F. EMPIALES, RM
TETANUS TOXOID GIVEN PRC LIC. #: 0126551
1 2 3 4 5
MARYCIL F. EMPIALES, RM
PRC LIC. #: 0141176
Number of previous pregnancy G____ P_____
_

OBSTETRICAL HISTORY YES NO Services offered:


3 Consecutive Miscarriage NEW BORN SCREENING
Still Birth
Postpartum Hemorrhage OB-GYNE clinic, Normal delivery by OB-
GYNE, Pre-natal Check-up, Normal Delivery
PRESENT HEALTH YES NO by MIDWIFE, Immunization, Family
PROBLEM Planning, Ear Piercing (HIKAW),
Tuberculosis Nebulization, IUD insertion and removal,
Heart Disease Papsmer
Diabetes
ULTRASOUND SCHEDULES:
Asthma
TUESDAY: 8:30 – 10:00 AM
Goiter
THURSDAY:8:30 – 10:00 AM
Haemophilla
SUNDAY: 4:00 – 6:00 PM

NAME:
Sibala’s lying-in
ADRESS: clinic
BLK36 LOT9 ZONE 11 AFP HOUSING,
AGE: 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
PRC LIC. #: 0141176
Number of previous pregnancy G____ P_____
_
Services offered:
OBSTETRICAL HISTORY YES NO
3 Consecutive Miscarriage NEW BORN SCREENING
Still Birth
Postpartum Hemorrhage OB-GYNE clinic, Normal delivery by OB-
GYNE, Pre-natal Check-up, Normal Delivery
PRESENT HEALTH YES NO by MIDWIFE, Immunization, Family
PROBLEM Planning, Ear Piercing (HIKAW),
Tuberculosis Nebulization, IUD insertion and removal,
Papsmer
Heart Disease
Diabetes
ULTRASOUND SCHEDULES:
Asthma
TUESDAY: 8:30 – 10:00 AM
THURSDAY:8:30 – 10:00 AM
SUNDAY: 4:00 – 6:00 PM
Goiter
haemohilla

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