PROFESSIONAL REGULATION COMMISSION

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

Name of Applicant: TOLENTINO, VALERIE ENRIQUEZ 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. Alea, 35 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 weeks Heramil Hospital
and 2 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 20-465 10/29/2020 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. 07:00 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
2. Christy Mae, 27 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 weeks Heramil Hospital
and 4 days Age of gestation, cephalic in labor, delivered Normal Spontaneous 20-467 11/1/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Boy with Apgar Score of 9, Birth Weight 3100 grams. 05:40 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
3. Ela Mae, 27 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 weeks Heramil Hospital
and 5 days Age of gestation, cephalic in labor, delivered Normal Spontaneous 20-469 11/2/2029 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Girl with Apgar Score of 9, Birth Weight 3200 grams. 04:10 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
4. Maria, 28 years old, Gravida 4 Para 4 (4004). Pregnancy Uterine 39 weeks Heramil Hospital
and 3 days Age of gestation, cephalic in labor, delivered Normal Spontaneous 20-471 11/2/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM clinical 0110062
Delivery to a live Baby Boy with Apgar Score of 9, Birth Weight 2900 grams. 11:00 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
5. Rollaine, 27 years old, Gravida 5 Para 5 (5005). Pregnancy Uterine 39 weeks Heramil Hospital
and 5 days Age of gestation, cephalic in labor, delivered Normal Spontaneous 20-473 11/3/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Girl with Apgar Score of 9, Birth Weight 3000 grams. 11:30 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
6. Juneilen, 30 years old, Gravida 4 Para 4 (4004). Pregnancy Uterine 39 weeks Heramil Hospital
and 2 days Age of gestation, cephalic in labor, delivered Normal Spontaneous 20-475 11/5/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Boy with Apgar Score of 9, Birth Weight 3200 grams. 12:40 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
7. Adelaida, 44 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 weeks Heramil Hospital
and 3 days Age of gestation, cephalic in labor, delivered Normal Spontaneous 20-477 11/7/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Girl with Apgar Score of 9, Birth Weight 3100 grams. 12:25 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
8. Lanny, 30 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 40 weeks Heramil Hospital
Age of gestation, cephalic in labor, delivered Normal Spontaneous 20-479 11/8/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Boy with Apgar Score of 9, Birth Weight 3000 grams. 03:40 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
9. Melanie, 25 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 weeks Heramil Hospital
and 4 days Age of gestation, cephalic in labor, delivered Normal Spontaneous 20-481 11/9/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Boy with Apgar Score of 9, Birth Weight 3200 grams. 02:55 P.M (083) 500-9247 09468758483 Instructor 2/5/2023
10. Daisy, 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 20-483 11/11/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Girl with Apgar Score of 9, Birth Weight 3500 grams. 06:50 A.M. (083) 500-9247 9468758483 Instructor 2/5/2023
 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
11. Mary Grace, 30 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 weeks Heramil Hospital
and 4 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 20-485 11/14/2020 Polomolok, South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Girl with an Apgar Score of 8, Birth Weight 2900 grams. 11:50 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
12. Michelle, 34 years old, Gravida 1 Para 1 (100). Pregnancy Uterine 39 weeks Heramil Hospital
and 3 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 20-487 11/16/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Girl with Apgar Score of 8, Birth Weight 3200 grams. 12:10 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
13. Lucille, 28 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 weeks Heramil Hospital
and 5 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 20-489 11/17/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Girl an Apgar Score of 8, Birth Weight 3400 grams. 05:00 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
14. Ivory, 27 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 weeks Heramil Hospital
and 2 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 20-491 11/18/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Girl with an Apgar Score of 8, Birth Weight 3500 grams. 06:30 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
15. Bebie Joyce, 27 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 weeks Heramil Hospital
and 4 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 20-493 11/19/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Boy with an Apgar Score of 8, Birth Weight 3500 grams. 11:00 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
16. Ena Eloisa, 24 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 weeks Heramil Hospital
and 5 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 20-495 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 3100 grams. 02:00 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
17. Noemia, 28 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 weeks Heramil Hospital
and 3 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 20-497 11/21/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Delivery to a live Baby Boy with an Apgar Score of 8, Birth Weight 3300 grams. 12:45 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
18. Ivy Joy, 28 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 20-499 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 3400 grams. 02:30 A.M. (082) 500-9247 09468758483 Instructor 2/5/2023
19. Jackie, 29 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 38 weeks Heramil Hospital
and 3 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 20-501 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 3500 grams. 10:20 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
20. Angrilyn, 26 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 39 weeks Heramil Hospital
and 6 days Age of Gestation, cephalic in labor, delivered Normal Spontaneous 20-503 11/24/2020 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. 05:00 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
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: 11/17/2021
 PROFESSIONAL REGULATION COMMISSION
Manila
BOARD OF MIDWIFERY
RECORD OF ACTUAL INTERNAL EXAMINATION
Please Check if Applicant is:

√ Graduate Midwife Registered Nurse

Name of Applicant: TOLENTINO, VALERIE ENRIQUEZ 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. Alea, 35 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine 39 weeks and 2 days Heramil Hospital
Age of Gestation, cephalic in labor, 7 cm dilated, 70 % effaced, Intact Bag of Water, 20-465 10/29/2020 Polomolok, South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
station 0. 03:50 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
2. Christy Mae, 27 years old, Gravida 1 Para 0. Pregnancy Uterine 39 weeks and 4 days Heramil Hospital
Age of Gestation, cephalic in labor, 9 cm dilated, 90% effaced, Ruptured Bag of Water, 20-467 11/1/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
amniotic fluid clear in color, station +2. 04:30 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
3. Ela Mae, 27 years old, Gravida 1 Para 0. Pregnancy Uterine 39 weeks and 5 days Heramil Hospital
Age of Gestation, cephalic in labor, 8 cm dilated, 80% effaced, Intact Bag of Water, 20-469 11/2/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
station +1. 02:00 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
4. Maria,28 years old, Gravida 4 Para 3 (3003). Pregnancy Uterine 39 weeks and 3 days Heramil Hospital
Age of Gestation, cephalic in labor, 6 cm dilated, 60% effaced, Intact Bag of Water, 20-471 11/2/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
station -1. 08:30 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
5. Rollaine May, 27 years old, Gravida 5 Para 4 (4004). Pregnancy Uterine 42 weeks Heramil Hospital
Age of Gestation, cephalic in labor, 7 cm dilated, 70% effaced, Intact Bag of Water, 20-473 11/3/2029 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
station +1. 09:00 P.M. (083) 500-9247 09468758483 Instructor 2/5/2022
6.Juneilen, 30 years old, Gravida 4 Para 3 (300). Pregnancy Uterine 39 weeks and 2 days Heramil Hospital
Age of Gestation, cephalic in labor,8 cm dilated, 80% effaced, Intact Bag of Water 20-475 11/5/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
station-1. 11:00 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
7. Adelaida, 44 years old, Gravida 1 Para 0. Pregnancy Uterine 39 weeks and 3 days Heramil Hospital
Age of Gestation, cephalic in labor, 9 cm dilated, 90% effaced, Ruptured Bag of Water, 20-477 11/17/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
station-1. 10:15 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
8.Lanny, 30 years old, Gravida 3 Para 2 (2002). Pregnancy Uterine 40 weeks Heramil Hospital
Age of Gestation, cephalic in labor, 9 cm dilated, 90% effaced, Ruptured Bag of Water, 20-479 11/8/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
amniotic fluid clear in color station+2. 02:00 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
9. Melanie, 25 years old, Gravida 1 Para 0. Pregnancy Uterine 39 weeks and 4 days Heramil Hospital
Age of Gestation, cephalic in labor, 9 cm dilated, 90% effaced, Ruptured Bag of Water, 20-481 11/9/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
amniotic fluid clear in color station +2. 01:15 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
10. Daisy, 26 years old, Gravida 1 Para 0. Pregnancy Uterine 39 weeks and 6 days Heramil Hospital
Age of Gestation, cephalic in labor, 7 cm dilated, 70% effaced, Intact Bag of Water 20-483 11/11/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
station 0. 03:30 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
 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
11. Mary Grace, 30 years old, Gravida 1 Para 0 . Pregnancy Uterine 39 weeks and Heramil Hospital
4 days Age of Gestation, cephalic in labor, 6 cm dilated, 60 % effaced, Intact Bag 20-485 11/14/2020 Polomolok, South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
of Water, station -1. 07:45 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
12. Michelle, 28 years old, Gravida 1 Para 0. Pregnancy Uterine 39 weeks and Heramil Hospital
3 days Age of Gestation, cephalic in labor, 7 cm dilated, 70% effaced, Intact Bag 20-487 11/16/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
of Water, station 0. 09:00 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
13. Lucille, 28 years old, Gravida 1 Para 0. Pregnancy Uterine 39 and Heramil Hospital
5 days Age of Gestation, cephalic in labor, 8 cm dilated,80% effaced, Intact Bag 20-489 11/17/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
of Water, station +1. 02:45 P.M (083) 500-9247 09468758483 Instructor 2/5/2023
14. Ivory, 27 years old, Gravida 1 Para 0. Pregnancy 39 weeks and Heramil Hospital
2 days Age of Gestation, cephalic in labor, 6 cm dilated,60% effaced, Intact Bag 20-491 11/18/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
of Water, station -1. 02:00 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
15. Bebie Joyce, 27 years old, Gravida 1 Para 0. Pregnancy Uterine 39 weeks and Heramil Hospital
5 days Age of Gestation, cephalic in labor, 8 cm dilated, 80% effaced, Intact Bag 20-493 11/19/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
of Water, station +1. 07:45 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
16. Ena Eloisa, 24 years old, Gravida 1 Para 0. Pregnancy Uterine 39 and Heramil Hospital
5 days Age of Gestation, cephalic in labor, 8 cm dilated, 80% effaced, Intact Bag 20-495 11/20/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
of Water, station +1. 11:30 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
17. Noemia, 28 years old, Gravida 1 Para 0. Pregnancy Uterine 39 weeks and Heramil Hospital
3 days Age of Gestation, cephalic in labor, 9 cm dilated, 90% effaced, Ruptured Bag 20-497 11/21/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
of Water, amniotic fluid clear in color, station +2. 11:35 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
18. Ivy Joy, 28 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine 39 weeks and Heramil Hospital
5 days Age of Gestation, cephalic in labor, 8 cm dilated,80% effaced, Intact Bag 20-499 11/23/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
of Water, station +1. 12:20 A.M. (083) 500-9247 08468758483 Instructor 2/5/2023
19. Jackie, 29 years old, Gravida 1 Para 0. Pregnancy Uterine 38 weeks and Heramil Hospital
2 days Age of Gestation, cephalic in labor, 8 cm dilated, 80% effaced, Intact Bag 20-501 11/23/2020 Polomolok South Cotabato SHIRLEY W. BRAVO Clinical 0110062
of Water, station +1. 08:00 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
20. Angrilyn, 26 years old, Gravida 3 Para 2 ( 2002). Pregnancy Uterine 39 weeks and Heramil Hospital
6 days Age of Gestation, cephalic in labor, 9 cm dilated, 90% effaced, Ruptured Bag 20-503 11/24/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
of Water, amniotic fluid clear in color, station + 2. 02:00 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
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: 11/17/2021
 PROFESSIONAL REGULATION COMMISSION
Manila
BOARD OF MIDWIFERY
RECORD OF ACTUAL INTRAVENOUS INSERTION
Please Check if Applicant is:

√ Graduate Midwife Registered Nurse

Name of Applicant: TOLENTINO, VALERIE ENRIQUEZ 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. Christy Mae, 27 years old, Gravida 1 Para 0. Pregnancy Uterine 39 weeks and 4 days Age of Gestation
cephalic in beginning labor. Heramil Hospital
Christy Mae, 27 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 weeks and 4 days Age of 20-467 11/1/2020 Polomolok, South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Gestation, cephalic normal spontaneous delivery to an alive term Baby Boy, Birth Weight 3300 grams, 04:35 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
Premature Rupture of Membrane x 3 hours.
2. Rollaine Mae, 27 years old, Gravida 5 Para 4 (4004). Pregnancy Uterine 42 weeks Age of Gestation,
cephalic in beginning labor. Heramil Hospital
Rollaine Mae, 27 years old, Gravida 5 Para 5 (5005). Pregnancy Uterine 42 weeks Age of 20-473 11/3/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Gestation, cephalic normal spontaneous delivery to an alive term Baby Girl, Birth Weight 3300 grams, 08:50 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
Multigravida.
3. Adelaida, 44 years old, Gravida 1 Para 0. Pregnancy Uterine 39 weeks and 3 days Age of Gestation,
cephalic in beginning labor. Heramil Hospital
Adelaida, 44 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 weeks and 3 days Age of 20-477 11/7/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Gestation, cephalic normal spontaneous delivery to an alive Baby Girl, Birth Weight 3100 grams, 10:00 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
Older Primigravida.
4. Noemia, 28 years old, Gravida 1 Para 0. Pregnancy Uterine 39 weeks and 3 days Age of Gestation,
cephalic in beginning labor. Heramil Hospital
Nomia, 28 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 weeks and 3 days Age of 20-497 11/21/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Gestation, cephalic normal spontaneous delivery to an alive term Baby Boy, Birth Weight 3400 grams. 11:40 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
Premature Ruptured Bag of Membrane x4 hours.
5. Angrilyn, 26 years old, Gravida 3 Para 2 (2002). Pregnancy Uterine 38 weeks and 2 days Age of Gesta
cephalic in beginning labor. Heramil Hospital
Angrilyn, 26 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 38 weeks and 2 days Age of 20-503 11/24/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
Gestation, cephalic normal spontaneous delivery to an alive term Baby Girl, Birth Weight 3300 grams, 02:10 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
Premature Ruptured of Membrane x3 hours.
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: 11/17/2021
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

Name of Applicant: TOLENTINO, VALERIE ENRIQUEZ School: SCHOLA DE SAN JOSE (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/ Signature License No./
Number Delivery Contact No. Designation Exp. Date
1. Alea, 35 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 weeks and 2 days Age of Heramil Hospital
Gestation, cephalic presentation, delivered Normal Spontaneous Delivery to a live term Baby girl 20-465 10/29/2020 Polomolok, South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
at 7:00a m, with an Apgar Score of 9, Birth Weight 3400 grams. Placenta delivered at 7:05 am, 07:22 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
Suture started 7:07 am - suture ended at 7:22 am. Second degree of perineal laceration repaired.
2. Ela Mae, 27 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 weeks and 5 days Age of Heramil Hospital
Gestation, cephalic presentation, delivered Normal Spontaneous Delivery to a live term Baby girl 20-469 11/2/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
at 4:10 am, with an Apgar Score of 9, Birth Weight 3200 grams. Placenta delivered at 4:15 am, 04:32 A.M. (083) 500-9247 09468758483 Instructor 2/5/2023
Suture started 4:17 am- suture ended at 4:32 am. Second degree of perineal laceration repaired.
3. Maria, 28 years old, Gravida 4 Para 4 (4004). Pregnancy Uterine 39 weeks and 5 days Age of Heramil Hospital
Gestation, cephalic presentation, delivered Normal Spontaneous Delivery to a live Baby term Baby b 20-471 11/2/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
at 11:00 pm, with an Apgar Score of 9, Birth Weight 3200 grams. Placenta delivered at 11:05 pm, 11:22 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
Suture started 11:07 pm - suture ended at 11:22 pm. First degree of perineal laceration repaired.
4. Juneilen, 30 years old, Gravida 4 Para 4 (4004). Pregnancy Uterine 39 weeks and 2 days Age of Heramil Hospital
Gestation, cephalic presentation, delivered Normal Spontaneous Delivery to a live Baby boy 20-475 11/5/2020 Polomolok South Cotabato SHIRLEY W. BRAVO, RM Clinical 0110062
at 12:40 pm, with an Apgar Score of 9, Birth Weight 3200 grams. Placenta delivered at 12:45 pm, 01:02 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
Suture started 12:47 pm - suture ended at 1:02 pm. Second degree of perineal laceration repaired.
5. Lanny, 30 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 40 weeks and 6 days Age of Heramil Hospital
Gestation, cephalic presentation, delivered Normal Spontaneous Delivery to a live term Baby boy 20-479 11/8/2020 Polomolok South Cotabato SHIRLEY W. BRAVO Clinical 0110062
at 3:40 pm, with an Apgar Score of 9, Birth Weight 3000 grams. Placenta delivered at 3:45 pm. 04:02 P.M. (083) 500-9247 09468758483 Instructor 2/5/2023
Suture started 3:47 pm - suture ended at 4:02 pm. Second 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 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: 11/17/2021