PRC FORM No.

107-A Republic of the Philippines

(Revised October 2010) HARDAM FURIGAY COLLEGES FOUNDATION INC.
P. Cuevas Street, Lamitan City, Basilan Province
BOARD OF MIDWIFERY
Record of Actual Deliveries Handled
Please Check:
Graduate Midwife Registered Nurse

Name of Applicant: JOHN ROSS R. ESTURCO School: HARDAM FURIGAY COLLEGES FOUNDATION INC.
Check Supervised by:
Complete Diagnosis Date & Full Name,
Name and Address of Case if
(Gravida_Para_) Time Address of Facility Printed Name & Position/ License No./
Patient No. Home Signature
Degree of Laceration Performed & Contact Number Contact No. Designation Expiration Date
Del.
1. Nilfa Haliddin Pregnancy Uterine Full Term 09/08/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Kulay DOS G2P2, Cephalic delivered via @ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
NSVD to a live baby Boy with an
Bato, Lamitan AS of 9, BW 3.1kg, with 1st 12:04PM City, Basilan 09057187461 Valid Until:
City, Basilan degree laceration and repaired Province July 5, 2019
Province
2. Amilun Suraina Pregnancy Uterine Full Term 9/12/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Baas, DOS G2P2, Cephalic delivered via @ 2:45am Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City, NSVD to a live baby Boy with City, Basilan 09057187461 Valid Until:
Basilan Province an AS of 8/9, BW 3.1kg, with Province July 5, 2019
1st degree laceration and
repaired
3. Asmida Nur Pregnancy Uterine Full 9/12/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Baas, Term G2P2, Cephalic @ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City, DOS delivered via NSVD to a 10:12am City, Basilan 09057187461 Valid Until:
Basilan live baby Girl with an AS of Province July 5, 2019
Province 9, BW 3.1kg, with 1st
degree laceration and
repaired
4. Rose Ann Pregnancy Uterine Full 9/12/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Augusto / DOS Term G3P3, Cephalic @ 3:59pm Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Brgy. Limook, delivered via NSVD to a City, Basilan 09057187461 Valid Until:
Lamitan City, live baby Girl with an AS of Province July 5, 2019
Basilan 8/9, BW 3.2kg, with 1st
degree laceration and
repaired
5. Jarma Ojan / Pregnancy Uterine Full 9/23/2018 Limook Birthing Cristal Jane U. Bentoy Clinical Midwife PRC no.
Brgy. Limook, DOS Term G2P2, Cephalic @ 2:14pm Facility, Lamitan RM. MPA Instructor 0164221
09057187461 Valid Until:
Lamitan City, delivered via NSVD to a City, Basilan July 5, 2019
Basilan live baby Boy with an AS Province
Province of 8/9, BW 3.2kg, with 1st
degree laceration and
repaired
6. Armira Jailani Pregnancy Uterine Full Term 9/25/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
/ DOS G2P2, Cephalic delivered via @ 4:25AM Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Brgy. Balobo, NSVD to a live baby Girl with City, Basilan 09057187461 Valid Until:
Lamitan City, an AS of 9, BW 3kg, with 2nd Province July 5, 2019
degree laceration and
Basilan
repaired
Province
7. Radzhata Joji Pregnancy Uterine Full 9/25/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
/ Brgy. DOS Term G2P2, Cephalic @ 7.32AM Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Sayugan, delivered via NSVD to a City, Basilan 09057187461 Valid Until:
Lamitan City, live baby Girl with an AS of Province July 5, 2019
Basilan 8, BW 2.7kg, with 2nd
Province degree laceration and
repaired
8. Marichelle Pregnancy Uterine Full 9/28/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Sergio / Brgy. DOS Term G2P2, Cephalic @ 7:10AM Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Matibay, delivered via NSVD to a City, Basilan 09057187461 Valid Until:
Lamitan City, live baby Girl with an AS of Province July 5, 2019
Basilan 9, BW 4kg, with 2nd
Province degree laceration and
repaired
9. Jaida Asama Pregnancy Uterine Full 9/28/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Tuburan, DOS Term G2P2, Cephalic @ 8:30AM Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Basilan delivered via NSVD to a City, Basilan 09057187461 Valid Until:
Province live baby Girl with an AS of Province July 5, 2019
8/9, BW 2.8kg, with 1st
degree laceration and
repaired
10. Rasida Akbar Pregnancy Uterine Full Term 10/3/18 @ Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy Matatag, DOS G2P2, Cephalic delivered via 5:55AM Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
NSVD to a live baby Boy with an
Lamitan City, AS of 8/9, BW 3.4kg, with 1st City, Basilan 09057187461 Valid Until:
Basilan degree laceration and repaired Province July 5, 2019
Province
11. Wadzna Pregnancy Uterine Full Term 10/3/18 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Asdain DOS G2P2, Cephalic delivered via @2:17PM Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
NSVD to a live baby Boy with an
Ungkaya AS of 9, BW 3.1kg, with 2nd City, Basilan 09057187461 Valid Until:
Pukan, Basilan degree laceration and repaired Province July 5, 2019
Province

12. Myra Maro Pregnancy Uterine Full Term 10/05/201 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Arco, DOS G2P2, Cephalic delivered via 8@ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
NSVD to a live baby girl with an
Lamitan City, AS of 8/9, BW 2.8kg, with 1st 11:50PM City, Basilan 09057187461 Valid Until:
Basilan degree laceration and repaired Province July 5, 2019
Province

13. Maimona Pregnancy Uterine Full 10/06/201 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Hairul / DOS Term G2P2, Cephalic 8@ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Ungkaya delivered via NSVD to a 2:35PM City, Basilan 09057187461 Valid Until:
Pukan, Basilan live baby Boy with an AS Province July 5, 2019
Province of 8/9, BW 3.2kg, with 2nd
degree laceration and
repaired
14. Bea Pregnancy Uterine Full 10/06/201 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Lamukaman/ DOS Term G2P2, Cephalic 8@ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Brgy. Cabobo, delivered via NSVD to a 11:48pm City, Basilan 09057187461 Valid Until:
Lamitan City, live baby Boy with an AS Province July 5, 2019
Basilan of 8/9, BW 2.7kg, with 2nd
Province degree laceration and
repaired

15. Haifa Albani / Pregnancy Uterine Full 10/08/201 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Maganda, DOS Term G3P3, Cephalic 8@ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City, delivered via NSVD to a 1:37PM City, Basilan 09057187461 Valid Until:
Basilan live baby Boy with an AS Province July 5, 2019
Province of 9, BW 2.7kg, with no
laceration.
16. Sira K. Alwa / Pregnancy Uterine Full 10/28/201 Lamitan District Cristal Jane U. Clinical Midwife PRC
Brgy. Lower 91- Term G6P6, Cephalic 8@ Hospital, Lamitan Bentoy RM. MPA Instructor no. 0164221
Bato-Bato, 245 delivered via NSVD to a 3:40am City, Basilan 09057187461 Valid Until:
Lamitan City, live baby Boy with an AS Province July 5, 2019
Basilan of 9, BW 3.0kg, with no
Province laceration
 17. Hanijan A. 91- Pregnancy Uterine Full 10/28/201 Lamitan District Cristal Jane U. Clinical Midwife PRC
Wabluha 246 Term G4P4, Cephalic 8 Hospital, Lamitan Bentoy RM. MPA Instructor no. 0164221
Brgy. Semut delivered via NSVD to a @5.:13am City, Basilan 09057187461 Valid Until:
Lamitan City, live baby Boy with an AS Province July 5, 2019
Basilan of 9, BW 2.9kg, with 2nd
Province degree laceration and
repaired
18. Nurhaya Amillul Pregnancy Uterine Full 11/01/201 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Sengal, Term G2P2, Cephalic 8@ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City, DOS delivered via NSVD to a 8:45PM City, Basilan 09057187461 Valid Until:
Basilan live baby Boy with an AS Province July 5, 2019
Province of 9, BW 3.0kg, with 2nd
degree laceration and
repaired
19. Saudia Abaran Pregnancy Uterine Full 11/02/201 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Sengal, DOS Term G2P2, Cephalic 8@ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City, delivered via NSVD to a 6:13AM City, Basilan 09057187461 Valid Until:
basilan live baby Boy with an AS Province July 5, 2019
Province of 9, BW 3.0kg, with 1st
degree laceration and
repaired
20. Honey Ascala / Pregnancy Uterine Full 11/02/201 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Balas, DOS Term G2P2, Cephalic 8@ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City, delivered via NSVD to a 6:49PM City, Basilan 09057187461 Valid Until:
Basilan live baby Boy with an AS Province July 5, 2019
Province of 9, BW 2.7kg, with 1st
degree laceration and
repaired

Note: 1. For graduate midwives: Supervision must be by qualified faculty/clinical instructor.

2. For registered Midwives who supervise students must present certificate of training on the Expanded Function as provided for under R.A 7392

SUBSCRIBED AND SWORN To before me this CERTIFIED CORRECT:

____________________ at _____________________Affiant
exhibiting to me his/her Residence Certificate No. _______________
issued at ________________________ on ___________________. Signature: ______________________ Date: ____________
Printed Name: BINHALID HARON DAMIL, RM,RN, MAN (CAR)
o
Designation: College Dean/Principal
License Number: 0147327 / 0513662 Expiry Date: 4/16/2020
Administer Officer or Notary Public Affix
Documentary Stamp
(to be posted on the last page)

PRC FORM No. 107-A Republic of the Philippines

(Revised October 2010) HARDAM FURIGAY COLLEGES FOUNDATION INC.
P. Cuevas Street, Lamitan City, Basilan Province
BOARD OF MIDWIFERY
Record of Actual Internal Examination
Please Check:
Graduate Midwife Registered Nurse

Name of Applicant: JOHN ROSS R. ESTURCO School: HARDAM FURIGAY COLLEGES FOUNDATION INC.

Full Name, Check Supervised by:

Complete Diagnosis Date &
Name and Address of Case Address of if
(Gravida_Para_) Time Printed Name & Position/ License No./
Patient No. Degree of Laceration Facility & Home Signature
Performed Contact No. Designation Expiration Date
Contact Number Del.
1. Myra Maro Pregnancy Uterine Full 10/05/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Arco, Term G2P2, Cephalic @ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City, delivered via NSVD to a 11:50PM City, Basilan 09057187461 Valid Until:
Basilan DOS live baby girl with an AS Province July 5, 2019
Province of 8/9, BW 2.8kg, with 1st
degree laceration and
repaired
2. Wadzna Asdain Pregnancy Uterine Full 10/3/18 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Ungkaya Term G2P2, Cephalic @2:17PM Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Pukan, Basilan DOS delivered via NSVD to a City, Basilan 09057187461 Valid Until:
Province live baby Boy with an AS Province July 5, 2019
of 9, BW 3.1kg, with 2nd
degree laceration and
repaired
3. Rasida Akbar Pregnancy Uterine Full 10/3/18 @ Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy Matatag, Term G2P2, Cephalic 5:55AM Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City, DOS delivered via NSVD to a live City, Basilan 09057187461 Valid Until:
Basilan baby Boy with an AS of 8/9, Province July 5, 2019
BW 3.4kg, with 1st degree
Province
laceration and repaired
4. Nilfa Haliddin Pregnancy Uterine Full 09/08/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Kulay Term G2P2, Cephalic @ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Bato, Lamitan DOS delivered via NSVD to a live 12:04PM City, Basilan 09057187461 Valid Until:
City, Basilan baby Boy with an AS of 9, Province July 5, 2019
BW 3.1kg, with 1st degree
Province
laceration and repaired
5. Amilun Suraina Pregnancy Uterine Full 9/12/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Baas, Term G2P2, Cephalic @ 2:45am Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City, DOS delivered via NSVD to a live City, Basilan 09057187461 Valid Until:
Basilan baby Boy with an AS of 8/9, Province July 5, 2019
Province BW 3.1kg, with 1st degree
laceration and repaired
6. Asmida Nur Pregnancy Uterine Full 9/12/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Baas, Term G2P2, Cephalic @ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City, DOS delivered via NSVD to a live 10:12am City, Basilan 09057187461 Valid Until:
Basilan baby Girl with an AS of 9, Province July 5, 2019
BW 3.1kg, with 1st degree
Province
laceration and repaired
7. Rose Ann Pregnancy Uterine Full 9/12/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Augusto / Term G3P3, Cephalic @ 3:59pm Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Brgy. Limook, DOS delivered via NSVD to a live City, Basilan 09057187461 Valid Until:
Lamitan City, baby Girl with an AS of 8/9, Province July 5, 2019
BW 3.2kg, with 1st degree
Basilan
laceration and repaired
8. Jarma Ojan / Pregnancy Uterine Full 9/23/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Limook, DOS Term G2P2, Cephalic @ 2:14pm Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City, delivered via NSVD to a live City, Basilan 09057187461 Valid Until:
Basilan baby Boy with an AS of 8/9, Province July 5, 2019
BW 3.2kg, with 1st degree
Province
laceration and repaired
9. Jaida Asama Pregnancy Uterine Full 9/28/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Tuburan, Term G2P2, Cephalic @ 8:30AM Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Basilan DOS delivered via NSVD to a live City, Basilan 09057187461 Valid Until:
Province baby Girl with an AS of 8/9, Province July 5, 2019
BW 2.8kg, with 1st degree
laceration and repaired
10. Marichelle Pregnancy Uterine Full 9/28/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Sergio / Brgy. Term G2P2, Cephalic @ 7:10AM Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Matibay, DOS delivered via NSVD to a City, Basilan 09057187461 Valid Until:
Lamitan City, live baby Girl with an AS Province July 5, 2019
Basilan of 9, BW 4kg, with 2nd
Province degree laceration and
repaired
11. Armira Jailani Pregnancy Uterine Full 9/25/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Balobo, Term G2P2, Cephalic @ 4:25AM Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City, DOS delivered via NSVD to a live City, Basilan 09057187461 Valid Until:
Basilan baby Girl with an AS of 9, Province July 5, 2019
BW 3kg, with 2nd degree
Province
laceration and repaired
12. Radzhata Joji Pregnancy Uterine Full 9/25/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
/ Brgy. Term G2P2, Cephalic @ 7.32AM Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Sayugan, DOS delivered via NSVD to a City, Basilan 09057187461 Valid Until:
Lamitan City, live baby Girl with an AS Province July 5, 2019
Basilan of 8, BW 2.7kg, with 2nd
Province degree laceration and
repaired
13. Maimona Pregnancy Uterine Full 10/06/201 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Hairul / Term G2P2, Cephalic 8@ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Ungkaya DOS delivered via NSVD to a 2:35PM City, Basilan 09057187461 Valid Until:
Pukan, Basilan live baby Boy with an AS Province July 5, 2019
Province of 8/9, BW 3.2kg, with
2nd degree laceration
and repaired
14. Haifa Albani / Pregnancy Uterine Full 10/08/201 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Maganda, Term G3P3, Cephalic 8@ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City, DOS delivered via NSVD to a 1:37PM City, Basilan 09057187461 Valid Until:
Basilan live baby Boy with an AS Province July 5, 2019
Province of 9, BW 2.7kg, with no
laceration.
15. Bea Pregnancy Uterine Full 10/06/201 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Lamukaman/ Term G2P2, Cephalic 8@ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Brgy. Cabobo, DOS delivered via NSVD to a 11:48pm City, Basilan 09057187461 Valid Until:
Lamitan City, live baby Boy with an AS Province July 5, 2019
Basilan of 8/9, BW 2.7kg, with
Province 2nd degree laceration
and repaired
16. Sira K. Alwa / Pregnancy Uterine Full 10/28/201 Lamitan District Cristal Jane U. Clinical Midwife PRC
Brgy. Lower 91- Term G6P6, Cephalic 8@ Hospital, Lamitan Bentoy RM. MPA Instructor no. 0164221
Bato-Bato, 245 delivered via NSVD to a 3:40am City, Basilan 09057187461 Valid Until:
Lamitan City, live baby Boy with an AS Province July 5, 2019
Basilan of 9, BW 3.0kg, with no
Province laceration
 17. Hanijan A. 91- Pregnancy Uterine Full 10/28/201 Lamitan District Cristal Jane U. Clinical Midwife PRC
Wabluha 246 Term G7P7, Cephalic 8 Hospital, Lamitan Bentoy RM. MPA Instructor no. 0164221
Brgy. Semut delivered via NSVD to a @5.:13am City, Basilan 09057187461 Valid Until:
Lamitan City, live baby Boy with an AS Province July 5, 2019
Basilan of 9, BW 2.9kg, with 2nd
Province degree laceration and
repaired
18. Nurhaya Pregnancy Uterine Full 11/01/201 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Amillul Term G2P2, Cephalic 8@ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Brgy. Sengal, DOS delivered via NSVD to a 8:45PM City, Basilan 09057187461 Valid Until:
Lamitan City, live baby Boy with an AS Province July 5, 2019
Basilan of 9, BW 3.0kg, with 2nd
Province degree laceration and
repaired
19. Honey Ascala Pregnancy Uterine Full 11/02/201 Limook Birthing Cristal Jane U. Clinical Midwife PRC
/ Brgy. Balas, Term G2P2, Cephalic 8@ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City, DOS delivered via NSVD to a 6:49PM City, Basilan 09057187461 Valid Until:
Basilan live baby Boy with an AS Province July 5, 2019
Province of 9, BW 2.7kg, with 1st
degree laceration and
repaired
20. Saudia Abaran Pregnancy Uterine Full 11/02/201 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Sengal, Term G2P2, Cephalic 8@ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City, DOS delivered via NSVD to a 6:13AM City, Basilan 09057187461 Valid Until:
basilan live baby Boy with an AS Province July 5, 2019
Province of 9, BW 3.0kg, with 1st
degree laceration and
repaired

Note: 1. For graduate midwives: Supervision must be by qualified faculty/clinical instructor.

2. For registered Midwives who supervise students must present certificate of training on the Expanded Function as provided for under R.A 7392

SUBSCRIBED AND SWORN To before me this CERTIFIED CORRECT:

____________________ at _____________________Affiant
exhibiting to me his/her Residence Certificate No. _______________
issued at ________________________ on ___________________. Signature: ______________________ Date: ____________
Printed Name: BINHALID HARON DAMIL, RM,RN, MAN (CAR)
o
Designation: College Dean/Principal
License Number: 0147327 / 0513662 Expiry Date: 4/16/2020
Administer Officer or Notary Public Affix
Documentary Stamp
(to be posted on the last page)

PRC FORM No. 107-A Republic of the Philippines

(Revised October 2010) HARDAM FURIGAY COLLEGES FOUNDATION INC.
P. Cuevas Street, Lamitan City, Basilan Province
BOARD OF MIDWIFERY
Record of Actual I.V ASSIST
Please Check:
 Graduate Midwife Registered Nurse

Name of Applicant: JOHN ROSS R. ESTURCO School: HARDAM FURIGAY COLLEGES FOUNDATION INC.
Full Name, Address of Check if Supervised by:
Complete Diagnosis Date & Time
Name and Address of Patient Case No. Facility & Contact Home Printed Name & Contact Position/ License No./
(Gravida_Para_) Performed Signature
Number Del. No. Designation Expiration Date
1. Nurhaya Amillul DOS Pregnancy Uterine Full 11/01/2018 @ Limook Birthing Cristal Jane U. Bentoy Clinical Midwife PRC no.
Brgy. Sengal, Lamitan Term G2P2 7:30pm Facility, Lamitan City, RM. MPA Instructor 0164221
City, D5LR @ Left cephalic Basilan Province 09057187461 Valid Until:
Vein @ 20gtts/mins July 5, 2019
2. Mercy Hadjirul DOS Pregnancy Uterine Full 9/23/2018 Limook Birthing Cristal Jane U. Bentoy Clinical Midwife PRC no.
Brgy. Bato, Lamitan City Term G3P3 @ 8:00am Facility, Lamitan City, RM. MPA Instructor 0164221
D5LR @ Left cephalic Basilan Province 09057187461 Valid Until:
Vein @ 20gtts/mins July 5, 2019
3. Hanijan A Wabluha 91-246 Pregnancy Uterine Full 10/28/2018 Lamitan District Cristal Jane U. Bentoy Clinical Midwife PRC no.
Semut, Lamitan City Term G2P2 @ 4:30am Hospital, Lamitan City, RM. MPA Instructor 0164221
D5LR @ Right cephalic Basilan Province 09057187461 Valid Until:
Vein @ 20gtts/mins July 5, 2019
4. Nidzma Enriquez DOS Pregnancy Uterine Full 09/02/2018 Limook Birthing Cristal Jane U. Bentoy Clinical Midwife PRC no.
L. Tabla, Basilan Term G2P2 @ 9PM Facility, Lamitan City, RM. MPA Instructor 0164221
Province D5LR @ Left cephalic Basilan Province 09057187461 Valid Until:
Vein @ 20gtts/mins July 5, 2019
5. Carmina Bayun DOS Pregnancy Uterine Full 09/07/2018 Limook Birthing Cristal Jane U. Bentoy Clinical Midwife PRC no.
Ungkaya Pukan , Term G2P2 @ 7:05PM Facility, Lamitan City, RM. MPA Instructor 0164221
Basilan D5LR @ Left cephalic Basilan Province 09057187461 Valid Until:
Vein @ 20gtts/mins July 5, 2019
Note: 1. For graduate midwives: Supervision must be by qualified faculty/clinical instructor.
2. For registered Midwives who supervise students must present certificate of training on the Expanded Function as provided for under R.A 7392

SUBSCRIBED AND SWORN To before me this CERTIFIED CORRECT:

____________________ at _____________________Affiant
exhibiting to me his/her Residence Certificate No. _______________ Signature: ______________________ Date: ____________
issued at ________________________ on ___________________. Printed Name: BINHALID HARON DAMIL, RM,RN, MAN (CAR)
o
Designation: College Dean/Principal
 Affix
Administer Officer or Notary Public Documentary Stamp
(to be posted on the last page)

PRC FORM No. 107-A Republic of the Philippines

(Revised October 2010) HARDAM FURIGAY COLLEGES FOUNDATION INC.
P. Cuevas Street, Lamitan City, Basilan Province
BOARD OF MIDWIFERY
Early Essential Newborn Care
Please Check:
 Graduate Midwife Registered Nurse

Name of Applicant: JOHN ROSS R. ESTURCO School: HARDAM FURIGAY COLLEGES FOUNDATION INC.

Check Supervised by:

Date & Full Name,
Name and Address of Case Complete Diagnosis if License No./
Time Address of Facility Printed Name & Position/
Patient No. (Gravida_Para_) Home Signature Expiration
Performed & Contact Number Contact No. Designation
Del. Date
1. BB Boy Halidin DOS Pregnancy Uterine Full 9/08/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Term G2P2, Cephalic @12:04PM Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City delivered via NSVD to a
live baby Boy with an AS City, Basilan 09057187461 Valid Until:
of 9. Province July 5, 2019
Antropometrics:
BW: 3.6kg
HC: 34cm
CC: 32
AC: 331cm,
Length: 53cm
2. Baby Boy Sumampil DOS Pregnancy Uterine Full 11/02/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Term G2P2, Cephalic @6:14pm Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City delivered via NSVD to a
live baby Boy with an AS City, Basilan 09057187461 Valid Until:
of 9. Province July 5, 2019
Antropometrics:
BW: 2.8kg
HC: 35 cm
CC: 32 cm
AC: 29 cm,
Length: 49 cm
 3. BB Boy Enriquez DOS Pregnancy Uterine Full 9/02/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Term G2P2, Cephalic @ 8:35pm Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City delivered via NSVD to a
live baby Boy with an AS City, Basilan 09057187461 Valid Until:
of 9. Province July 5, 2019
Antropometrics:
BW: 2.8 kg
HC: 35 cm
CC: 32 cm
AC: 30 cm,
Length: 51cm
4. BB Boy Aharal, DOS Pregnancy Uterine Full 08/30/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Term G3P3, Cephalic @6:36pm Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Basilan Province delivered via NSVD to a
live baby Boy with an AS City, Basilan 09057187461 Valid Until:
of 9. Province July 5, 2019
Antropometrics:
BW: 3.0kg
HC: 35cm
CC: 32
AC: 30cm,
Length: 51cm
5. BB Girl Akbar Pregnancy Uterine Full 07//07/20 DJMT Hospital, Cristal Jane U. Clinical Midwife PRC
Term G2P2, Cephalic Lamitan City, Bentoy RM. MPA Instructor no. 0164221
Basilan Province delivered via NSVD to a 18
live baby Girl with an AS @8pm Basilan Province 09057187461 Valid Until:
of 9. July 5, 2019
Antropometrics:
BW: 2.7 kg
HC: 32.5 cm
CC: 30
AC: 30.5 cm,
Length: 50 cm
Note: 1. For graduate midwives: Supervision must be by qualified faculty/clinical instructor.
2. For registered Midwives who supervise students must present certificate of training on the Expanded Function as provided for under R.A 7392

SUBSCRIBED AND SWORN To before me this CERTIFIED CORRECT:

____________________ at _____________________Affiant
exhibiting to me his/her Residence Certificate No. _______________
issued at ________________________ on ___________________. Signature: ______________________ Date: ____________
Printed Name: BINHALID HARON DAMIL, RM,RN, MAN (CAR)
o
Designation: College Dean/Principal
License Number: 0147327 / 0513662 Expiry Date: 4/16/2020
Administer Officer or Notary Public Affix
Documentary Stamp
(to be posted on the last page)
 PRC FORM No. 107-A Republic of the Philippines
(Revised October 2010) HARDAM FURIGAY COLLEGES FOUNDATION INC.
P. Cuevas Street, Lamitan City, Basilan Province
BOARD OF MIDWIFERY
Record of Actual Repair/ Suturing of Perineal Laceration

Please Check:
 Graduate Midwife Registered Nurse
Name of Applicant: JOHN ROSS R. ESTURCO School: HARDAM FURIGAY COLLEGES FOUNDATION INC.
Check Supervised by:
Date & Full Name,
Name and Address of Case Complete Diagnosis if License No./
Time Address of Facility Printed Name & Position/
Patient No. (Gravida_Para_) Home Signature Expiration
Performed & Contact Number Contact No. Designation
Del. Date
1. Alma Abdulsalam DOS Pregnancy Uterine Full 10/09/2018 Limook Birthing Cristal Jane U. Bentoy Clinical Midwife PRC
Parang Basak, Term G2P2, with 1st @ 5AM Facility, Lamitan RM. MPA Instructor no. 0164221
degree laceration and 09057187461 Valid Until:
Lamitan City repaired City, Basilan
Province July 5, 2019
2. Carmina Bayun DOS Pregnancy Uterine Full 09/07/2018 Limook Birthing Cristal Jane U. Bentoy Clinical Midwife PRC
Ungkaya Pukan Term G2P2, with 2nd @6:55PM Facility, Lamitan RM. MPA Instructor no. 0164221
degree laceration and 09057187461 Valid Until:
Basilan Province repaired City, Basilan
Province July 5, 2019
3. Reynaly F. Sanoy DOS Pregnancy Uterine Full 08/26/201 Limook Birthing Cristal Jane U. Bentoy Clinical Midwife PRC
Colonia, Lamitan Term G2P2, with 2nd Facility, Lamitan RM. MPA Instructor no. 0164221
degree laceration and 8
City City, Basilan 09057187461 Valid Until:
repaired @7:10pm July 5, 2019
Province
4. Bashma Calutot DOS Pregnancy Uterine Full 9/13/2018 Limook Birthing Cristal Jane U. Bentoy Clinical Midwife PRC
Badja, Basilan Term G2P2, with 1st Facility, Lamitan RM. MPA Instructor no. 0164221
degree laceration and
@11:40pm
Province City, Basilan 09057187461 Valid Until:
repaired July 5, 2019
Province
5. Amilun Suraima DOS Pregnancy Uterine Full 9/12/2018 Limook Birthing Cristal Jane U. Bentoy Clinical Midwife PRC
Baas, Lamitan City Term G2P2, with 2nd Facility, Lamitan RM. MPA Instructor no. 0164221
degree laceration and @2:45am
09057187461 Valid Until:
repaired
 City, Basilan July 5, 2019
Province
Note: 1. For graduate midwives: Supervision must be by qualified faculty/clinical instructor.
2. For registered Midwives who supervise students must present certificate of training on the Expanded Function as provided for under R.A 7392

SUBSCRIBED AND SWORN To before me this CERTIFIED CORRECT:

____________________ at _____________________Affiant Signature: ______________________ Date: ____________
exhibiting to me his/her Residence Certificate No. _______________ Affix Printed Name: BINHALID HARON DAMIL, RM,RN, MAN (CAR)
issued at ________________________ on ___________________. Documentary Stamp
(to be posted on the last page)
o
PRC FORM No. 107-A Republic of the Philippines Designation: College Dean/Principal
Administer Officer
(Revised October 2010) or Notary Public HARDAM FURIGAY COLLEGES FOUNDATION License INC. Number: 0147327 / 0513662 Expiry Date: 4/16/2020
P. Cuevas Street, Lamitan City, Basilan Province
Administer Officer or Notary Public BOARD OF MIDWIFERY
Record of Actual Assisted Delivery
Please Check:
 Graduate Midwife Registered Nurse

Name of Applicant: JOHN ROSS R. ESTURCO School: HARDAM FURIGAY COLLEGES FOUNDATION INC.

Full Name, Address Check if Supervised by:

Case Complete Diagnosis Date & Time
Name and Address of Patient of Facility & Contact Home Printed Name & Contact Position/ License No./
No. (Gravida_Para_) Performed Signature
Number Del. No. Designation Expiration Date
1. Mercy Hadjirul DOS Pregnancy Uterine 9/23/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Bato, Lamitan City Full Term G3P3, @ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Cephalic delivered 7:50am City, Basilan 09057187461 Valid Until:
via NSVD to a live Province July 5, 2019
baby girl
2. Bashma Calutot DOS Pregnancy Uterine 9/13/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Badja, Basilan Full Term G2P2 @ 8:23pm Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Province Cephalic delivered City, Basilan 09057187461 Valid Until:
via NSVD to a live Province July 5, 2019
baby boy
3. Silma Abbas DOS Pregnancy Uterine 9/13/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Maganda, Full Term G3P3, @11:40PM Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City Cephalic delivered City, Basilan 09057187461 Valid Until:
via NSVD to a live Province July 5, 2019
baby boy
4. Nidzma Enriquez Pregnancy Uterine 9/02/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
L. Tablas, Basilan Full Term G2P2, @8:35pm Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Province Cephalic delivered 09057187461 Valid Until:
 via NSVD to a live City, Basilan July 5, 2019
baby girl Province
5. Reynaly F. Pregnancy Uterine 08/26/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Sanoy Full Term G2P2, @ 7:10pm Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Colonia, Lamitan Cephalic delivered City, Basilan 09057187461 Valid Until:
City via NSVD to a live Province July 5, 2019
baby boy
6. Carmina Bayun DOS Pregnancy Uterine 09/07/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Ungkayapukan, Full Term G2P2, @ 6:55PM Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Basilan Province Cephalic delivered City, Basilan 09057187461 Valid Until:
via NSVD to a live Province July 5, 2019
baby girl
7. Hajara Alih DOS Pregnancy Uterine 09/26/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Brgy. Sengal, Full Term G2P2, @ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City Cephalic delivered 10:28pm City, Basilan 09057187461 Valid Until:
via NSVD to a live Province July 5, 2019
baby Boy
8. Jenny Maranie DOS Pregnancy Uterine 9/25/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Al Barka, Basilan Full Term G2P2, @ Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Province Cephalic delivered 1:25PM City, Basilan 09057187461 Valid Until:
via NSVD to a live Province July 5, 2019
baby girl
9. Hamida DOS Pregnancy Uterine 9/25/18 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Abdulajill Full Term G2P2, @ 1:24am Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Colonia, Lamitan Cephalic delivered City, Basilan 09057187461 Valid Until:
City via NSVD to a live Province July 5, 2019
baby boy
10. Aida Hiya DOS Pregnancy Uterine 9/24/2018 Limook Birthing Cristal Jane U. Clinical Midwife PRC
Maloong Canal, Full Term G2P2, @ 7PM Facility, Lamitan Bentoy RM. MPA Instructor no. 0164221
Lamitan City Cephalic delivered City, Basilan 09057187461 Valid Until:
via NSVD to a live Province July 5, 2019
baby boy
Note: 1. For graduate midwives: Supervision must be by qualified faculty/clinical instructor.
2. For registered Midwives who supervise students must present certificate of training on the Expanded Function as provided for under R.A 7392

CERTIFIED CORRECT:
SUBSCRIBED AND SWORN To before me this
____________________ at _____________________Affiant
exhibiting to me his/her Residence Certificate No. _______________
issued at ________________________ on ___________________.
Signature: ______________________ Date: ____________
Printed Name: BINHALID HARON DAMIL, RM,RN, MAN (CAR)
o
Designation: College Dean/Principal
Administer Officer or Notary Public
License Number: 0147327 / 0513662 Expiry Date: 4/16/2020
 Affix
Documentary Stamp
Administer Officer or Notary Public (to be posted on the last page)