PROFESSIONAL REGULATION COMMISSION

Manila
BOARD OF MIDWIFERY
RECORD OF ACTUAL DELIVERIES HANDLED
Please Check if Applicant is:
Graduate Midwife Registered Nurse
Name of Applicant: CABIZARES, KARYL GARING School: SCHOLA DE SAN JOSE (Formerly: Provincial Technical Institute for Southern Mindanao)
Case Date and Full Name, Address of Facility Check if Supervised by:
Name and Complete Diagnosis (Gravida __ Para __) No. Time & Contact Number Home
Performe Delivery Printed Name & Contact Position/ Signature License No./
d No. Designation Exp. Date
1. Janice, 34 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine Emelia Ancuna- Amante Birthing
39 weeks and 1 day Age of Gestation, cephalic in labor, delivered 2020-169 05/21/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Normal Spontaneous Delivery to a live Baby boy with an Apgar Score 09:38 P.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
of 8, birth Weight 3,900 grams. 09094616941 09094616941
2. Dianne Lou, 30 years old, Gravida 2 Para 2 (2002). Pregnancy Emelia Ancuna- Amante Birthing
Uterine 39 weeks and 4 days Age of Gestation, cephalic in labor, 2020-172 05/23/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
delivered Normal Spontaneous Delivery to a live Baby girl with an 02:40 A.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
Apgar Score of 8, birth Weight 3,200 grams. 09094616941 09094616941
3. Marilyn, 23 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine Emelia Ancuna- Amante Birthing
38 weeks and 5 days Age of Gestation, cephalic in labor, delivered 2020-176 05/24/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Normal Spontaneous Delivery to a live Baby girl with an Apgar Score 08:26 A.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
of 9, birth Weight 2,900 grams. 09094616941 09094616941
4. Ching, 32 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing
38 weeks and 4 days Age of Gestation, cephalic in labor, delivered 2020-177 05/25/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Normal Spontaneous Delivery to a live Baby boy with an Apgar Score 09:26 A.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
of 8, birth Weight 2,900 grams. 09094616941 09094616941
5. Mary Jane, 41 years old, Gravida 3 Para 3 (3003). Pregnancy Emelia Ancuna- Amante Birthing
Uterine 39 weeks Age of Gestation, cephalic in labor, delivered 2020-181 05/27/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Normal Spontaneous Delivery to a live Baby boy with an Apgar Score 03:56 P.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
of 9, birth Weight 2,600 grams. 09094616941 09094616941
6. Bethel, 27 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing
40 weeks Age of Gestation, cephalic in labor, delivered Normal 2020-182 05/29/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 9, 12:10 A.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
Birth Weight 2,900 Grams. 09094616941 09094616941
7. Jenniber, 25 years old, Gravida 2 Para 1 (2011). Pregnancy Uterine Emelia Ancuna- Amante Birthing
39 weeks and 2 days Age of Gestation, cephalic in labor, delivered 2020-185 05/31/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Normal Spontaneous Delivery to a live Baby boy with an Apgar of 01:24 A.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
Score 9, birth Weight 2,500 grams. 09094616941 09094616941
8. Janlyn, 22 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing
38 weeks Age of Gestation, cephalic in labor, delivered Normal 2020-187 06/01/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Spontaneous Delivery to live Baby boy with an Apgar Score of 9, birth 02:55 A.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
Weight 3,100 grams. 09094616941 09094616941
9. Sheny Mae, 28 years old, Gravida 2 Para 2 (2002). Pregnancy Emelia Ancuna- Amante Birthing
Uterine 38 weeks Age of Gestation, cephalic in labor, delivered 2020-188 06/02/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Normal Spontaneous Delivery to a live Baby girl with an Apgar Score 10:01 P.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
of 8, birth Weight 2,800 grams. 09094616941 09094616941
10. Angile, 18 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing
 39 weeks and 4 days Age of Gestation, cephalic in labor, delivered 2020-189 06/03/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Normal Spontaneous Delivery to a live Baby boy with an Apgar Score 10:16 P.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
of 8, birth Weight 3,600 grams. 09094616941 09094616941
Case Date and Full Name, Address of Facility Check if Supervised by:
Name and Complete Diagnosis (Gravida __ Para __) No. Time & Contact Number Home
Performe Delivery Printed Name & Contact Position/ Signature License No./
d No. Designation Exp. Date
11. Amelisa, 28 years old, Gravida 2 Para 2 (2002). Pregnancy Emelia Ancuna- Amante Birthing
Uterine 39 weeks Age of Gestation, cephalic in labor, delivered 2020-192 06/04/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Normal Spontaneous Delivery to a live Baby girl with an Apgar Score 04:05 A.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
of 9, birth weight 2,600 grams. 09094616941 09094616941
12. Jean, 28 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine Emelia Ancuna- Amante Birthing
40 weeks Age of Gestation, cephalic in labor, delivered Normal 2020-199 06/06/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8, 04:35 A.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
birth Weight 3,000 grams. 09094616941 09094616941
13. Janet, 36 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine Emelia Ancuna- Amante Birthing
39 weeks and 4 days Age of Gestation, cephalic in labor, delivered 2020-201 06/07/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Normal Spontaneous Delivery to a live Baby boy with an Apgar Score 07:10P.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
of 9, birth Weight 3,400 grams. 09094616941 09094616941
14. Laizah, 29 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing
40 weeks 5 days Age of Gestation, cephalic in labor, delivered Normal 2020-202 06/08/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Spontaneous Delivery to a live Baby girl with an Apgar Score of 9, 08:15 A.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
birth Weight 2,900 grams. 09094616941 09094616941
15. Lovelyn, 34 years old, Gravida 3 Para 3 (3003). Pregnancy Emelia Ancuna- Amante Birthing
Uterine 39 weeks Age of Gestation, cephalic in labor, delivered 2020-204 06/08/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Normal Spontaneous Delivery to a live Baby boy with an Apgar of 01:10 P.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
Score 8, birth Weight 2,900 grams. 09094616941 09094616941
16. Marissa, 29 years old, Gravida 2 Para 2 (2002). Pregnancy Emelia Ancuna- Amante Birthing
Uterine 39 weeks and 4 days Age of Gestation, cephalic in labor, 2020-206 06/09/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
delivered Normal Spontaneous Delivery to a live Baby boy with an 10:37 P.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
Apgar Score of 9, birth Weight 3,200 grams. 09094616941 09094616941
17. Irish, 33 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 39 Emelia Ancuna- Amante Birthing
weeks 5 days Age of Gestation, cephalic in labor, delivered Normal 2020-207 06/10/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Spontaneous Delivery to a live Baby girl with an Apgar Score of 9, 04:35 A.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
birth Weight 2,900 grams. 09094616941 09094616941
18. Rejane, 22 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing
38 weeks 5 days Age of Gestation, cephalic in labor, delivered Normal 2020-208 06/11/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Spontaneous Delivery to a live Baby boy with an Apgar Score of 8, 02:47 A.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
birth 3,800 grams. 09094616941 09094616941
19. Vina, 23 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine Emelia Ancuna- Amante Birthing
39 weeks 5 days Age of Gestation, cephalic in labor, delivered Normal 2020-212 06/13/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Spontaneous Delivery to a live boy with an Apgar Score of 8, birth 04:20 A.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
Weight 3,700 grams. 09094616941 09094616941
20. Karel, 37 years old, Gravida 6 Para 6 (6006). Pregnancy Uterine Emelia Ancuna- Amante Birthing
38 weeks Age of Gestation, cephalic in labor, delivered Normal 2020-219 06/20/2020 Home EMELIA A. AMANTE, RM, Clinical 0108299
Spontaneous Delivery to a live Baby girl with an Apgar Score of 9, 10:12 A.M. Polomolok, South Cotabato BCHS Instructor 11/17/2022
birth Weight 3,500 grams. 09094616941 09094616941
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: CABIZARES, KARYL GARING School: SCHOLA DE SAN JOSE (Formerly: Provincial Technical Institute for Southern Mindanao)
Case Date and Full Name, Address of Facility & Check if Supervised by:
Name and Complete Diagnosis (Gravida __ Para __) No. Time Contact Number Home
Performed Delivery Printed Name & Contact Position/ Signature License No./
No. Designation Exp. Date
1. Janice, 34 years old, Gravida 3 Para 2 (2002). Pregnancy Emelia Ancuna- Amante Birthing Home
Uterine 39 weeks and 1 day Age of Gestation, cephalic in labor, 2020-169 05/21/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM, Clinical 0108299
8cm dilated, 80% effaced, Intact Bag of Water, station +1. 07:30 P.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
2. Dianne Lou, 30 years old, Gravida 2 Para 1 (1001). Pregnancy Emelia Ancuna- Amante Birthing Home
Uterine 39 weeks and 4 days Age of Gestation, cephalic in labor, 2020-172 05/23/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM, Clinical 0108299
10cm dilated, 100% effaced, Intact Bag of Water, station +3. 02:00 A.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
3. Marilyn, 23 years old, Gravida 1 Para 0. Pregnancy Uterine 38 Emelia Ancuna- Amante Birthing Home
weeks and 5 days Age of Gestation, cephalic in labor, 10cm 2020-176 05/24/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM, Clinical 0108299
dilated, 100% effaced, Intact Bag of Water, station +3. 08:00 A.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
4. Ching, 32 years old, Gravida 2 Para 1 (1001). Pregnancy Emelia Ancuna- Amante Birthing Home
Uterine 38 weeks and 4 days Age of Gestation, cephalic in labor, 2020-177 05/25/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM, Clinical 0108299
10cm dilated 100% effaced, Intact Bag of Water, Station +3. 09:00 A.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
5. Mary Jane, 41 years old, Gravida 3 Para 2 (2002). Pregnancy Emelia Ancuna- Amante Birthing Home
Uterine 39 weeks Age of Gestation, cephalic in labor 9cm dilated, 2020-181 05/27/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM, Clinical 0108299
90% effaced, Intact Bag of Water, Station+2. 03:00 P.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
6. Bethel, 27 years old, Gravida 2 Para 1 (1001). Pregnancy Emelia Ancuna- Amante Birthing Home
Uterine 40 weeks Age of Gestation, cephalic in labor 10cm 2020-182 05/28/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM, Clinical 0108299
dilated, 100% effaced, Intact Bag of Water, station +4. 11:50 P.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
7. Jenniber, 25 years old, Gravida 2 Para 0 (0010). Pregnancy Emelia Ancuna- Amante Birthing Home
Uterine 39 weeks and 2 days Age of Gestation, cephalic in labor, 2020-185 05/31/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM, Clinical 0108299
9cm dilated, 90% effaced, Intact Bag of Water, station +2. 12:28 A.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
8. Janlyn, 23 years old, Gravida 2 Para 1 (1001). Pregnancy Emelia Ancuna- Amante Birthing Home
Uterine 38 weeks Age of Gestation, cephalic in labor, 10cm 2020-187 06/01/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM, Clinical 0108299
dilated 100% effaced, Intact Bag of Water, station +3. 02:00 A.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
9. Sheny Mae, 28 years old, Gravida 2 Para 1 (1001). Pregnancy Emelia Ancuna- Amante Birthing Home
Uterine 38 weeks Age of Gestation, cephalic in labor, 7cm dilated, 2020-188 06/02/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM, Clinical 0108299
80% effaced, Intact Bag of Water, station 0. 07:00 P.M. 09094616941 BCHS Instructor 11/17/2022
09094616941
10. Angile, 18 years old, Gravida 2 Para 1 (1001). Pregnancy Emelia Ancuna- Amante Birthing Home
 Uterine 39 weeks and 4 days Age of Gestation, cephalic in labor, 2020-189 06/03/2020 Polomolok, South Cotabato EMELIA A. AMANTE, RM, Clinical 0108299
10cm dilated, 100% effaced, Intact Bag of Water, station +2. 09:50 P.M. 09094616941 BCHS Instructor 11/17/2022
09094616941

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 & Contact Position/ Signature License No./
y No. Designation Exp. Date
11. Amelisa, 28 years old, Gravida 2 Para 1 (1001). Pregnancy Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM,
Uterine 39 weeks Age of Gestation, cephalic in labor, 10cm 2020-192 06/04/2020 Polomolok, South Cotabato BCHS Clinical 0108299
dilated, 100% effaced, Intact Bag of Water, station +3. 03:40 A.M. 09094616941 09094616941 Instructor 11/17/2022

12. Jean, 28 years old, Gravida 3 Para 2 (2002). Pregnancy Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM,
Uterine 40 weeks Age of Gestation, cephalic in labor, 8cm dilated, 2020-199 06/06/2020 Polomolok, South Cotabato BCHS Clinical 0108299
80% effaced, Intact Bag of Water, station 0. 02:30 A.M. 09094616941 09094616941 Instructor 11/17/2022
13. Janet, 36 years old, Gravida 3 Para 2 (2002). Pregnancy Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM,
Uterine 39 weeks and 4 days Age of Gestation, cephalic in labor, 2020-201 06/07/2020 Polomolok, South Cotabato BCHS Clinical 0108299
10cm dilated, 100% effaced, Intact Bag of Water, station +3. 06:40P.M 09094616941 09094616941 Instructor 11/17/2022
14. Laizah, 29 years old, Gravida 2 Para 1 (1001). Pregnancy Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM,
Uterine 40 weeks and 5 days Age of Gestation, cephalic in labor, 2020-202 06/08/2020 Polomolok, South Cotabato BCHS Clinical 0108299
10cm dilated, 100% effaced, Intact Bag of Water, station +4. 07:53 A.M. 09094616941 09094616941 Instructor 11/17/2022
15. Lovelyn, 34 years old, Gravida 3 Para 2 (2002). Pregnancy Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM,
Uterine 39 weeks Age of Gestation, cephalic in labor, 9cm dilated, 2020-204 06/08/2020 Polomolok, South Cotabato BCHS Clinical 0108299
90% effaced, Intact Bag of Water, station +2. 12:00 P.M. 09094616941 09094616941 Instructor 11/17/2022
16. Marissa, 29 years old Gravida 2 Para 1 (1001). Pregnancy Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM,
Uterine 39 weeks and 4 days Age of Gestation, cephalic in labor, 2020-206 06/09/2020 Polomolok, South Cotabato BCHS Clinical 0108299
8cm dilated, 90% effaced, Intact Bag of Water, station +1. 07:40 P.M. 09094616941 09094616941 Instructor 11/17/2022
17. Irish, 33 years old, Gravida 3 Para 2 (2002). Pregnancy Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM,
Uterine 39 weeks and 5 days Age of Gestation, cephalic in labor, 2020-207 06/10/2020 Polomolok, South Cotabato BCHS Clinical 0108299
7cm dilated, 80% effaced, Intact Bag of Water, station +0. 01:27 A.M. 09094616941 09094616941 Instructor 11/17/2022
18. Rejane, 22 years old, Gravida 2 Para 1 (1001). Pregnancy Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM,
Uterine 38 weeks and 5 days Age of Gestation, cephalic in labor, 2020-208 06/11/2020 Polomolok, South Cotabato BCHS Clinical 0108299
10cm dilated, 100% effaced, Intact Bag of Water, station +3. 02:10 A.M. 09094616941 09094616941 Instructor 11/17/2022
19. Vina, 23 years old, Gravida 2 Para 1(1001). Pregnancy Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM,
Uterine 39 weeks and 5 days Age of Gestation, cephalic in labor, 2020-212 06/13/2020 Polomolok, South Cotabato BCHS Clinical 0108299
9cm dilated, 90% effaced, Intact Bag of Water, station +2. 03:13 A.M. 09094616941 09094616941 Instructor 11/17/2022
20. Karel, 37 years old, Gravida 6 Para 5 (5005). Pregnancy Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM,
Uterine 38 weeks Age of Gestation, cephalic in labor, 10cm 2020-219 06/20/2020 Polomolok, South Cotabato BCHS Clinical 0108299
dilated, 100% effaced, Intact Bag of Water, station +4. 10:00 A.M. 09094616941 09094616941 Instructor 11/17/2022
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: CABIZARES, KARYL GARING School: SCHOLA DE SAN JOSE (Formerly: Provincial Technical Institute for Southern Mindanao)
Case Date and Full Name, Address of Facility & Check if Supervised by:
Name and Complete Diagnosis (Gravida __ Para __) No. Time Contact Number Home
Performed Delivery Printed Name & Position/ Signature License No./
Contact No. Designation Exp. Date
1. Janice, 34 years old, Gravida 3 Para 3 (3003). Pregnancy Uterine 39
weeks and 1 day Age of Gestation, cephalic presentation delivered Normal 2020-169 05/21/2020 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM, Clinical 0108299
Spontaneous Delivery to a live Baby boy at 9:38 P.M. with an Apgar Score Polomolok, South Cotabato Instructor
10:06 P.M. BCHS 11/17/2022
of 8, Birth Weight 3,900 grams. Placenta delivered at 9:43 P.M, suture 09094616941
started 9:46 PM – suture ended 10:06 PM. Second Degree of perineal
09094616941
laceration repaired.
2. Dianne lou, 30 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39
weeks and 4 days Age of Gestation, cephalic presentation, delivered 2020-172 05/23/2020 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM, Clinical 0108299
Normal Spontaneous Delivery to a live baby girl at 2:40 A.M. with an Apgar Polomolok, South Cotabato Instructor
03:03 A.M. BCHS 11/17/2022
Score 8, Birth Weight 3,200 grams. Placenta delivered at 2:45 A.M, suture 09094616941
started 2:48 AM – suture ended 3:03 A.M. First Degree of perineal
09094616941
laceration repaired.
3. Angile, 18 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39
weeks and 4 days Age of Gestation, cephalic presentation, delivered 2020-189 06/03/2020 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM, Clinical 0108299
Normal Spontaneous Delivery to a live Baby boy at 10:16 P.M. with an Polomolok, South Cotabato Instructor
10:48 P.M. BCHS 11/17/2022
Apgar Score of 8, Birth Weight 3,600 grams. Placenta delivered at 10:22 09094616941
P.M, suture started 10:25 PM – suture ended 10:48 PM. Second Degree of
09094616941
perineal laceration repaired.
4. Rejane, 22 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 38
weeks and 5 days Age of Gestation, cephalic presentation, delivered 2020-208 06/11/2020 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM, Clinical 0108299
Normal Spontaneous Delivery to a live Baby boy at 2:47 A.M. with an Apgar Polomolok, South Cotabato Instructor
03:17 A.M. BCHS 11/17/2022
Score 8, Birth Weight 3,800 grams. Placenta delivered at 2:52 A.M, suture 09094616941
started 2:56 AM – suture ended 3:17 A.M. Second Degree of perineal
09094616941
laceration repaired.
5. Vina, 23 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39
weeks and 5 days Age of Gestation, cephalic presentation, delivered 2020-212 06/13/2020 Emelia Ancuna- Amante Birthing Home EMELIA A. AMANTE, RM, Clinical 0108299
Normal Spontaneous Delivery to a live Baby girl at 4:20 A.M. with an Apgar Polomolok, South Cotabato Instructor
04:44 A.M. BCHS 11/17/2022
Score 8, Birth Weight 3,700 grams. Placenta delivered at 4:25 A.M, suture 09094616941
started 4:28 AM – suture ended 4:44 A.M. First Degree of perineal
09094616941
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: CABIZARES, KARYL GARING 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. Alea, 35 years old, Gravida 2 Para 1 (1001). Pregnancy Uterine 39
weeks and 2 days Age of Gestation, cephalic in beginning labor. 20-465 10/29/2020 Heramil Hospital SHIRLEY W. BRAVO, RM Clinical 0110062
Alea, 35 years old, Gravida 2 Para 2 (2002). Pregnancy Uterine 39 04:00 A.M Polomolok, South Cotabato 09468758483 Instructor 02/05/2023
weeks and 2 days Age of Gestation, Normal Spontaneous Delivery to (083) 500-9247
an alive term Baby Girl, Birth Weight 3,400 grams, Premature Rupture
of Membrane x 3 hours with meconium stained.
2. Ela Mae, 27 years old, Gravida 1 Para 0. Pregnancy Uterine 39 weeks
and 5 days Age of Gestation, cephalic in beginning labor. 20-469 11/02/2020 Heramil Hospital SHIRLEY W. BRAVO, RM Clinical 0110062
Ela Mae, 27 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 02:12 A.M. Polomolok, South Cotabato 09468758483 Instructor 02/05/2023
weeks and 5 days Age of Gestation, Normal Spontaneous Delivery to an
(083) 500-9247
alive term Baby Girl, Birth Weight 3,200 grams, Premature Rupture of
Membrane x 2 hours.
3. Mary Grace, 30 years old, Gravida 1 Para 0. Pregnancy Uterine 39
weeks and 4 days Age of Gestation, cephalic in beginning labor. 20-485 11/14/2020 Heramil Hospital SHIRLEY W. BRAVO, RM Clinical 0110062
Mary Grace, 30 years old, Gravida 1 Para 1 (1001). Pregnancy 08:00 P.M. Polomolok, South Cotabato 09468758483 Instructor 02/05/2023
Uterine 39 weeks and 4 days Age of Gestation, Normal Spontaneous (083) 500-9247
Delivery to an alive term Baby girl, Birth Weight 2,900 grams, Older
Primigravida.
4. Ivory, 27 years old, Gravida 1 Para 0. Pregnancy Uterine 39 weeks
and 2 days Age of Gestation, cephalic in beginning labor. 20-491 11/18/2020 Heramil Hospital SHIRLEY W. BRAVO, RM Clinical 0110062
Ivory, 27 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 02:22 P.M. Polomolok, South Cotabato 09468758483 Instructor 02/05/2023
weeks and 2 days Age of Gestation, Normal Spontaneous Delivery to (083) 500-9247
an alive term Baby girl, Birth Weight 3,500 grams, Premature Rupture of
Membrane x 4 hours.
5. Bebie, 27 years old, Gravida 1 Para 0. Pregnancy Uterine 39 weeks
and 5 days Age of Gestation, cephalic in beginning labor. 20-493 11/19/2020 Heramil Hospital SHIRLEY W. BRAVO, RM Clinical 0110062
Bebie, 27 years old, Gravida 1 Para 1 (1001). Pregnancy Uterine 39 09:10 P.M. Polomolok, South Cotabato 09468758483 Instructor 02/05/2023
weeks and 5 days Age of Gestation, Normal Spontaneous Delivery to (083) 500-9247
an alive term Baby boy, Birth Weight 3,500 grams, Premature Rupture
of Membrane x 2 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
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:
___________________________________________ Signature: ______________ Date: _______________
Administering Officer or Notary Public Printed Name: WILMA T. HERAMIL, MD
Designation: Principal/Chairman Health Services Education Unit
License No.: 0078733 Expiry Date: 11/17/2024