1. PROFESSIONAL REGULATION COMMISSION
Manila
BOARD OF MIDWIFERY
Record of Actual Intravenous Insertion/Infusion
Name of Applicant: JOAN CABASAG School: MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Name and Address of Diagnosis Date Full Name and Address Case No. Check SUPERVISED BY: THE FACULTY
Patient Performed of Facility if Print Name Position/ Signature License
Home Designation No./Exp.
Del Date
De Guzman, Zosimay Pregnancy Uterine Full term, April 8,2010 Amang Rodriguez Memorial 049295 Josephine Uy Ybaez RM, Clinical 0056871/0
194 Celli Austria Cephalic in Labor 38 wks Age of Medical Center RN Instructor 258060
Gestation Gravida 2 Para 2 Marikina City
Bagumbayan Q.C (2002)
Alvear, Analyn Arididon Pregnancy Uterine Full term, April 9 2010 Amang Rodriguez Memorial 042917 Josephine Uy Ybaez RM, Clinical 0056871/0
464 Ubas St. Rd. Cephalic in Labor, Gravida 4 Para Medical Center RN Instructor 258060
4 (4004) Marikina City
Paradise Malanday City
Miranda Diana Pregnancy Uterine Full term, July 27 2010 Cagayan Valley Medical Center 074017 Aurelio Cachola Jr. Clinical 0384738
Cabagan Isabela Cephalic in Labor 40 wks Age of Carig Sur, Tuguegarao City RN,RM,MSN Instructor
Gestation Gravida 2
Para 2 (2002)
Galletes Necy Pregnancy Uterine Full term, July 27 2010 Cagayan Valley Medical Center 035065 Aurelio Cachola Jr. Clinical 0384738
Amulung Cagayan Cephalic in Labor 38 wks Age of Carig Sur, Tuguegarao City RN,RM,MSN Instructor
Gestation Gravida 2 Para 2
(2002)
Tebia,Lita Pregnancy Uterine Full term, July 27 2010 Cagayan Valley Medical Center 072146 Aurelio Cachola Jr. Clinical 0384738
Cabagan Isabela Cephalic in Labor 39 wks Age of Carig Sur, Tuguegarao City RN,RM,MSN Instructor
Gestation Gravida 2 Para 2
(2002)
SUBSCRIBED AND SWORN TO before me this __________________ at _____________________ affiant
Exhibiting to me his/her certificate No. _______________ issued at __________________ on __________________
________________ Affix CERTIFIED CORRECT:
Notary Public Signature: _______________________ Date: ______________________
Documentary Stamp ( to be posted on the last Designation: ________________________________________________
page of every case) License No.: ____________________ Expiry Date: __________________

2. PROFESSIONAL REGULATION COMMISSION
Manila
BOARD OF MIDWIFERY
Record of Actual Repair of Perineal Lacerations
Name of Applicant: JOAN CABASAG School: MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Name and Address of Diagnosis Date Full Name and Address Case No. Check SUPERVISED BY: THE FACULTY
Patient Performed of Facility if Print Name Position/ Signature License
Home Designation No./Exp.
Del Date
Marilyn Semania Pregnancy Uterine Full term, Jan. 29,2010 Cagayan Midwives Cooperative 0321 Rosario E. Ramirez Clinical 09411931
4
Tuguegarao, City Cephalic in Labor 38 /7 wks Birthing Center RN, RM, MSN Instructor
Age of Gestation Gravida 1 Tuguegarao City
Para 1 (1001)
Lizel Castillo Pregnancy Uterine Full term, Feb.09,2011 Cagayan Midwives Cooperative 0563 Virginia Lejos RN Clinical 0419869
Solana Cagayan Cephalic in Labor Gravida 1 Birthing Center Instructor
Para 1 (1001) Tuguegarao City
Reyes Monita Pregnancy Uterine Full term, Mar.30,2010 Jose R. Reyes Memorial 0053504 Beatriz Sawal RN Clinical 0122581
1249 Brgy. Milagrosa Cephalic in Labor 40 wks Age of Medical Center Instructor
Gestation Gravida 2 Manila
Carmona Cavite Para 2 (2002)
Delosa, Rowena Pregnancy Uterine Full term, Apr.09,2010 Amang Rodriguez Memorial 038109 Josephine Uy Ybaez RM, Clinical 0056871/
Maira Corazon Sta. Cruz A.C Cephalic in Labor Gravida 1 Medical Center RN Instructor 0258060
Para 1 (1001) Marikina City
Miranda Diana Pregnancy Uterine Full term, Jul.27,2010 Cagayan Valley Medical Center 074017 Aurelio Cachola Jr. Clinical 0384738
Solana Cagayan Cephalic in Labor 39 wks Age of Carig Sur, Tuguegarao City RN,RM,MSN Instructor
Gestation Gravida 2 Para 2
(2002)
SUBSCRIBED AND SWORN TO before me this ___________________ at ______________________ affiant
Exhibiting to me his/her certificate No. _______________ issued at _____________________ on __________________
________________ Affix CERTIFIED CORRECT:
Notary Public Signature: ________________________ Date: _____________________
Documentary Stamp ( to be posted on the last Designation: ________________________________________________
page of every case) License No.: ____________________ Expiry Date: __________________

3. PROFESSIONAL REGULATION COMMISSION
Manila
BOARD OF MIDWIFERY
Record of Actual Deliveries Handled
Name of Applicant: JOAN CABASAG School: MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Name and Address of Patient Diagnosis Date Full Name and Address of Case Check SUPERVISED BY: THE FACULTY
Performed Facility No. if Print Name Position/ Signature License
Home Designation No./Exp.
Del Date
Marilyn Semania Pregnancy Uterine Full term, Cephalic in Labor 38 Jan. 29,2010 Cagayan Midwives Cooperative Rosario E. Ramirez Clinical 09411931
4
/7 wks Age of Gestation Gravida 1 Para 1 (1001)
0321
Tuguegarao, City Birthing Center RN, RM, MSN Instructor
Tuguegarao City
Buenaventura, Lady Ann Pregnancy Uterine Full term, Cephalic in Labor 39 Apr.05,2010 Jose R. Reyes Memorial Medical 241254 Cielito Sanvictores Clinical 0169335
wks Age of Gestation Gravida 1 Para 1 (1001)
37 Kalinisan St. Galod Q.C Center Hatt RM,RM,MAN Instructor
Manila
Carbonel,Jonalyn Pregnancy Uterine Full term, Cephalic in Labor 39 Jul. 26,2010 Cagayan Valley Medical Center 074156 Aurelio Cachola Jr. Clinical 0384738
wks Age of Gestation Gravida 1 Para 1 (1001)
Piat Cagayan Carig Sur, Tuguegarao City RN,RM,MSN Instructor
Galletes, Necy Pregnancy Uterine Full term, Cephalic in Labor 38 July 27 2010 Cagayan Valley Medical Center 035065 Aurelio Cachola Jr. Clinical 0384738
wks Age of Gestation Gravida 2 Para 2 (2002) Carig Sur, Tuguegarao City
Amulung Cagayan RN,RM,MSN Instructor
Gabun,Myrna Pregnancy Uterine Full term, Cephalic in Labor 38 July 27 2010 Cagayan Valley Medical Center 074028 Aurelio Cachola Jr. Clinical 0384738
wks Age of Gestation Gravida 2 Para 2 (2002) Carig Sur, Tuguegarao City
Solana, Cagayan RN,RM,MSN Instructor
Rovina Perez Pregnancy Uterine Full term, Cephalic in Labor 39 Feb. 08, 2011 Cagayan Midwives Cooperative 0643 Virginia Lejos RN Clinical 0419869
wks Age of Gestation Gravida 2 Para 2 (2002)
Tuguegarao City Birthing Center Instructor
Tuguegarao City
Elizel Boado Pregnancy Uterine Full term, Cephalic in Labor 39 Jan.08,2010  Lorna B. De Laza RM Rural Health 0072310/
3
/7 wks Age of Gestation Gravida 3 Para 3 (3003)
Pata, Tuao, Cagayan Midwife 09-17-2011
Rosemarie Abig Pregnancy Uterine Full term, Cephalic in Labor 38 Jan.24,2010  Lorna B. De Laza RM Rural Health 0072310/
4
/7 wks Age of Gestation Gravida 1 Para 1 (1001)
Pata, Tuao, Cagayan Midwife 09-17-2011
Arlene Ramos Pregnancy Uterine Full term, Cephalic in Labor 39 Jan.30,2010  Lorna B. De Laza RM Rural Health 0072310/
6
/7 wks Age of Gestation Gravida 3 Para 3 (3003)
Pata, Tuao, Cagayan Midwife 09-17-2011
Glazy Jane Lagundi Pregnancy Uterine Full term, Cephalic in Labor 40 June 22,2010  Lorna B. De Laza RM Rural Health 0072310/
6
/7 wks Age of Gestation Gravida 2 Para 2 (2002)
Pata, Tuao, Cagayan Midwife 09-17-2011
SUBSCRIBED AND SWORN TO before me this _______________________ at ________________________affiant
Exhibiting to me his/her certificate No. ______________ issued at _______________________________ on _________________________
________________ Affix CERTIFIED CORRECT:
Notary Public Signature: _________________________________ Date: ________________________
Documentary Stamp ( to be posted on the last Designation: ____________________________________________________________
page of every case) License No.: ____________________________ Expiry Date: ______________________

4. PROFESSIONAL REGULATION COMMISSION
Manila
BOARD OF MIDWIFERY
Record of Actual Deliveries Handled
Name of Applicant: JOAN CABASAG School: MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Name and Address of Patient Diagnosis Date Full Name and Address of Case Check SUPERVISED BY: THE FACULTY
Performed Facility No. if Print Name Position/ Signature License
Home Designation No./Exp.
Del Date
Vicenta Arciga Pregnancy Uterine Full term, Cephalic in Oct. 08,2010  Lorna B. De Laza RM Rural Health 0072310/
Labor 39 2/7 wks Age of Gestation Gravida 09-17-2011
Pata, Tuao, Cagayan Midwife
3 Para 3 (3003)
Liza Cabasag Pregnancy Uterine Full term, Cephalic in Nov.12,2010  Lorna B. De Laza RM Rural Health 0072310/
Labor 40 wks Age of Gestation Gravida 2 09-17-2011
Pata, Tuao, Cagayan Midwife
Para 2 (2002)
Irene Amorsolo Pregnancy Uterine Full term, Cephalic in Nov.24,2010  Lorna B. De Laza RM Rural Health 0072310/
Labor 35 5/7 wks Age of Gestation Gravida 09-17-2011
Pata, Tuao, Cagayan Midwife
2 Para 2 (2002)
Analyn Lamusao Pregnancy Uterine Full term, Cephalic in Dec.02,2010  Lorna B. De Laza RM Rural Health 0072310/
Labor 37 wks Age of Gestation Gravida 5 09-17-2011
Pata, Tuao, Cagayan Midwife
Para 5 (5005)
Matira Casauay Pregnancy Uterine Full term, Cephalic in Dec.19, 2010  Lorna B. De Laza RM Rural Health 0072310/
Labor 40 1/7 wks Age of Gestation Gravida 09-17-2011
Pata, Tuao, Cagayan Midwife
1 Para 1 (1001)
Nora Garcia Pregnancy Uterine Full term, Cephalic in Dec. 19,2010  Lorna B. De Laza RM Rural Health 0072310/
Labor 38 5/7 wks Age of Gestation Gravida 7 09-17-2011
Pata, Tuao, Cagayan Midwife
Para 7 (7007)
Marilou Mammaril Pregnancy Uterine Full term, Cephalic in Dec. 22,2010  Lorna B. De Laza RM Rural Health 0072310/
Labor 38 2/7 wks Age of Gestation Gravida 09-17-2011
Pata, Tuao, Cagayan Midwife
3 Para 3 (3003)
Conception Lorenzo Pregnancy Uterine Full term, Cephalic in Dec.29,2010  Lorna B. De Laza RM Rural Health 0072310/
Labor 40 1/7 wks Age of Gestation Gravida 09-17-2011
Pata, Tuao, Cagayan Midwife
1 Para 1 (1001)
Marissa Cabasag Pregnancy Uterine Full term, Cephalic in Jan.09,2011  Lorna B. De Laza RM Rural Health 0072310/
Labor 40 1/7 wks Age of Gestation Gravida 09-17-2011
Pata, Tuao, Cagayan Midwife
2 Para 2 (2002)
Grace Lappay Pregnancy Uterine Full term, Cephalic in Feb.13,2011  Lorna B. De Laza RM Rural Health 0072310/
Labor 39 5/7 wks Age of Gestation Gravida 09-17-2011
Pata, Tuao, Cagayan Midwife
2 Para 2 (2002)
SUBSCRIBED AND SWORN TO before me this _______________________ at ________________________affiant
Exhibiting to me his/her certificate No. ______________ issued at _______________________________ on _________________________
________________ Affix CERTIFIED CORRECT:
Notary Public Signature: _________________________________ Date: ________________________
Documentary Stamp ( to be posted on the last Designation: ____________________________________________________________
page of every case) License No.: ____________________________ Expiry Date: ______________________