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  • Tausa, Iv

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    Reingin Semanero
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    This document records Angelica Montevirgen Tausa's actual intravenous fluid insertions as a graduate midwife under the supervision of Marciel N. Salvador, a registered nurse and midwife. It lists 5 patients that Tausa inserted IV fluids for between January 15, 2020 and February 28, 2020 at the BEmONC San Jose facility in Occidental Mindoro, Philippines. Each entry includes the patient's name and diagnosis, date and time of the procedure, as well as the supervising midwife's printed name, contact number, position, signature, and license information. The document is certified by the program head of the midwifery department and notarized.

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    TAUSA,IV

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    This document records Angelica Montevirgen Tausa's actual intravenous fluid insertions as a graduate midwife under the supervision of Marciel N. Salvador, a registered nurse and midwife. It lists 5 patients that Tausa inserted IV fluids for between January 15, 2020 and February 28, 2020 at the BEmONC San Jose facility in Occidental Mindoro, Philippines. Each entry includes the patient's name and diagnosis, date and time of the procedure, as well as the supervising midwife's printed name, contact number, position, signature, and license information. The document is certified by the program head of the midwifery department and notarized.

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    © All Rights Reserved
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    4 views4 pages

    Tausa, Iv

    Uploaded by

    Reingin Semanero
    This document records Angelica Montevirgen Tausa's actual intravenous fluid insertions as a graduate midwife under the supervision of Marciel N. Salvador, a registered nurse and midwife. It lists 5 patients that Tausa inserted IV fluids for between January 15, 2020 and February 28, 2020 at the BEmONC San Jose facility in Occidental Mindoro, Philippines. Each entry includes the patient's name and diagnosis, date and time of the procedure, as well as the supervising midwife's printed name, contact number, position, signature, and license information. The document is certified by the program head of the midwifery department and notarized.

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    of 4

    Professional Regulation Commission

    RECORD OF ACTUAL INTRAVENOUS FLUID INSERTIONS

    Please Check:
    Graduate Midwife Registered Nurse
    Name of Applicant: TAUSA, ANGELICA MONTEVIRGEN School: OCCIDENTAL MINDORO STATE COLLEGE

    Name and Address Case No. Complete Diagnosis Date & Time Full Name Supervised by
    of Patient Performed Address of Facility Printed Name & Position/ Signature License No./
    & Contact Number Contact No. Designation Expiration Date
    1. Glory Joy F. Biato, 170942 G1P0(1000) PUFT 38 weeks AOG by 1/15/2020 BEmONC San Jose MARCIEL N. SALVADOR, RN, RM, MAN Clinical 0153456
    16 years old LMP, Cephalic in labor, BP 08:41 am Barangay 7, San Jose, 0926-015-0853 Instructor 11/16/2022
    Ilin, San Jose, 140/90mmHg, FHT 178 bpm. Occidental Mindoro
    Occidental Mindoro (043)-457-0902
    2. Christina M. Portacio, 167532 G1P0(1000) PUFT 39 weeks AOG by 1/24/2020 BEmONC San Jose MARCIEL N. SALVADOR, RN, RM, MAN Clinical 0153456
    31 years old LMP, Cephalic in labor, BP 06:10 pm Barangay 7, San Jose, 0926-015-0853 Instructor 11/16/2022
    Purnaga, Magsaysay, 170/100mmHg, FHT 188 bpm. Occidental Mindoro
    Occidental Mindoro (043)-457-0902
    3. Mina S. Gonzales, 171519 G1P0(1000) PUFT 39 weeks AOG by 1/31/2020 BEmONC San Jose MARCIEL N. SALVADOR, RN, RM, MAN Clinical 0153456
    16 years old LMP, Cephalic in labor, BP 80/60mmHg 11:00 am Barangay 7, San Jose, 0926-015-0853 Instructor 11/16/2022
    Malpalon, Calintaan, with mild vaginal bleeding. Occidental Mindoro
    Occidental Mindoro (043)-457-0902
    4. Angel T. Amador, 161554 G1P0(0100) PUFT 36 weeks AOG by 2/13/2020 BEmONC San Jose MARCIEL N. SALVADOR, RN, RM, MAN Clinical 0153456
    19 years old LMP, Cephalic in labor, febrile (38.0oc), 04:45 pm Barangay 7, San Jose, 0926-015-0853 Instructor 11/16/2022
    Poblacion Magsaysay, BP 110/60mmHg with spotting vaginal Occidental Mindoro
    Occidental Mindoro bleeding. (043)-457-0902
    5. Cristie G. Mandapat, 138435 G1P0(1000) PUFT 40 2/7 weeks AOG by 2/28/2020 BEmONC San Jose MARCIEL N. SALVADOR, RN, RM, MAN Clinical 0153456
    22 years old LMP, Cephalic in labor, febrile (38.5oc), 10:10 am Barangay 7, San Jose, 0926-015-0853 Instructor 11/16/2022
    Batasan, San Jose, BP 90/60mmHg with moderate vaginal Occidental Mindoro
    Occidental Mindoro bleeding. (043)-457-0902
    Note: 1) Registered Midwives/Clinical Instructors who supervise Students/Graduate Midwives/Registered Nurses and affix their signature in this Form must present a
    Certificate of Training on Expanded Functions of Midwife (R.A. 7392) pursuant to Board Resolution No. 07, Series of 2017, dated September 8, 2017.

    SUBSCRIBED AND SWORN TO before me this ______________at CERTIFIED CORRECT:


    ______________ affiant exhibiting to me his/ her Residence Signature:_______________Date:____________
    Certificate No. 27788878 issued at San Jose, Occidental Mindoro Printed Name: JO ANN RECEPCION-MALBAS, RM, RN, MAN
    on 08/31/2022. Designation: Program Head-Midwifery Department PRBSEC-48
    Rev. 00
    License Number: 0130349 Expiry Date: 06/06/2024 January 24, 2020
    __________________ Page 2 of 2
    NOTARY PUBLIC
    PRBSEC-48
    Rev. 00
    January 24, 2020
    Page 3 of 3

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