PROFESSIONAL REGULATION COMMISSION

Manila
BOARD OF MIDWIFERY

Records of Actual Deliveries Handled

Please check if the Applicant is:
Graduate Midwife
Name of Applicant: TANIOLA, WELLA JOIE C.
Name and Address
of the Patient

Case No.

Complete Diagnosis
(Gravida_Para_)

School: BROKENSHIRE COLLEGE SOCSKSARGEN INC.

Date & Time
Performed

Full name, Address of the

Facility & Contact No.

Supervised By:
Printed Name &
Contact No.

1.

Ramirez, Karen Dyne

1402002136

Calabanit, Glan
Sarangani Province

2.

Dayanan, Cherlita

1403002842

Purok 8A Alabel
Sarangani Province
3.

4.

Tusan, Stephanie
Aiza
Purok 10 Alabel
Poblacion Sarangani
Province
Pines, Jocelyn

1405004337

1405004725

Balite, Lagao
General Santos City
5.

Legaspi, Juvelyn

1406005966

Purok 8A Poblacion
Malapatan,
Sarangani Province
6

Bautista, Maria
Cristy
Zone 2-C Bula
General Santos City

1406005957

Registered Nurse

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a male neonate in cephalic
presentation, 39 weeks and 6/7 days Age
of Gestation, Gravida 1 Para 0

February 26, 2014

8:59 pm

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a female neonate in cephalic
presentation, 38 weeks Age of Gestation,
Gravida 2 Para 1

March 18, 2014

11:21 am

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a male neonate in cephalic
presentation, 38 weeks Age of Gestation,
Gravida 1 Para 0

May 8, 2014
8:50 pm

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a male neonate in cephalic
presentation, 39 weeks Age of Gestation,
Gravida 1 Para 0

May 15, 2014

8:04 pm

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a male neonate in cephalic
presentation, 40 weeks Age of Gestation,
Gravida 2 Para 1

June 19, 2014

8:49 pm

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a female neonate in cephalic
presentation, 39 weeks Age of Gestation,
Gravida 12 Para 11 Pre-Eclampsia, severe

June 20, 2014

10:01 am

General Santos City Hospital

Arline J.Magan

083-3015866

09325148837

Position/
Designation
Clinical
Instructor

Signature

License No./ Exp. Date

License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837-

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

Arline J.Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

7.

Torregoza, Teodora

1407006439-B

Poblacion
Malapatan,
Sarangani Province
8.

Manza, Flordeliz

1407006472

Purok Kalonlama
Kihan
9.

Beto, Ana Rose

14070069440.

Purok 2, Tinagacan
General Santos City
10.

Eclapis, Barbara

11.

Block 16, Lot 5

Employees Village,
Fatima General
Santos City
Alcantara, Marjilyn

12

13.

Purok San Nicolas

Lun Padido,
Malapatan Sarangani
Province
Jover, Honey Pearl
Ire
Purok Pisces Street,
Calumpang General
Santos City
Alinsugay, Bebeth

1407006967

1407007166

1407007234

1407007450

Purok 5 Poblacion
Malapatan Sarangani
Province
14.

Mamada, Lynlyn

1408008056

San Juan, Silway

Dadiangas West
General Santos City
15.

Abiso, Anacel
Tinago 9-B,
Dadiangas South
General Santos City

1408008236

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a female neonate in cephalic
presentation, 40 weeks and 3/7 days Age
of Gestation, Gravida 8 Para 9

July 3, 2014
7:59 am

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a male neonate in cephalic
presentation, 38 weeks and 2/7 days Age
of Gestation, Gravida 1 Para 0

July 4, 2014
7:40 am

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a female neonate in cephalic
presentation, 41 weeks and 1/7day Age of
Gestation, Gravida 2 Para 1 Pre-Eclampsia

July 18, 2014

3:50 pm

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a female neonate in cephalic
presentation, 38 weeks and 4/7 days Age
of Gestation, Gravida 1 Para 0, PreEclampsia, severe
Pregnancy Uterine Full Term in labor
delivered via Normal Spontaneous Vaginal
Delivery to a female neonate in cephalic
presentation, 40 weeks and 1/7 day Age of
Gestation, Gravida 3 Para 2, Previous
Ceasarian
Pregnancy Uterine Full Term in labor
delivered via Normal Spontaneous Vaginal
Delivery to a male neonate in cephalic
presentation, 38 weeks Age of Gestation,
Gravida 2 Para 1

July 18, 2014

10:00 pm

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a male neonate in cephalic
presentation, 40 week Age of Gestation,
Gravida 1 Para 0

July 31, 2014

2:48 pm

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a female neonate in cephalic
presentation, 39 weeks Age of Gestation,
Gravida 4 Para 3 Abortion 1

August 16, 2014

6:13 pm

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a female neonate in cephalic
presentation, 39 weeks and 6/7 days Age
of Gestation, Gravida1 Para 0

August 22, 2014

8:02 am

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837-

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

July 24, 2014

7:07 pm

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

July 26, 2014

3:44 pm

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

16.

Recibas, Magdalena

1408008265

Purok 2 Ligaya
General Santos City
17.

Franco, Miaflor

1409009243

Labangal, General
Santos City
18

Ensomo, Rebecca

1409009519

Calumpang, General
Santos City
19.

Dianga, Junalyn

1410009763

Malalag, Cogon
Malungon Sarangani
Province
20.

Villarba, Madelyn

1410010000

Purok Balunto
Labangal General
Santos City

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a male neonate in cephalic
presentation, 39-40 weeks Age of
Gestation, Gravida 7 Para 6

August 22, 2014

12:46 pm

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a male neonate in cephalic
presentation, 38 weeks Age of Gestation,
Gravida 8 Para 7

September 18, 2014

10:35 am

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a male neonate in cephalic
presentation,40 weeks and 6/7 days Age
of Gestation, Gravida 1 Para 0

September 25, 2014

12:35 pm

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a male neonate in breech
presentation footling, 41 weeks and 2/7
days Age of Gestation, Gravida 2 Para 1

October 2, 2014
11:19 am

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous Vaginal
Delivery to a male neonate in cephalic
presentation, 39 weeks and 3/7 days Age
of Gestation, Gravida 1 Para 0

October 9, 2014
8:50 am

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

Arline J. Magan

083-3015866

09325148837

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

Note: 1.) for graduate midwives: Supervision must be by qualified/ clinical instructor.
2.) Registered Midwifes/ Clinical Instructors who supervise the student midwives and the affix their signature in this form must be present a Certificate of Training on Intravenous 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.02735805 issued at General Santos City on March 11, 2013

Administering Officer or Notary Public

Affix
Doc. Stamp
(To be posted on the last
page)

CERTIFIED CORRECT:

Signature:_______________Date:___________

PROFESSIONAL REGULATION COMMISSION

Manila
BOARD OF MIDWIFERY
Records of Cord Dressing
Please check if the Applicant is:
Graduate Midwife
Name of Applicant: TANIOLA, WELLA JOIE C.

No.

1.

Date of Birth
and Time

January 26,
2014

Family
Name of
Child

Sex

Soriba

Female

Mother

Soriba, Jane

School: BROKENSHIRE COLLEGE SOCSKSARGEN INC.

Weight
In lbs.

6.38 lbs.

Length
In
Cms.

Head
Cms.

48 cm

33 cm

Temperature

36.8 C

Name who
Cord Dressed

Taniola, Wella Joie C.

6:30 pm
2.

March 04,
2014

Female

Rosales,
Jenive

6.38 lbs.

47 cm

34 cm

37.5 C

Taniola, Wella Joie C.

12:02 pm
3.

March 11,
2014

March 17,
2014

Madio

Female

Madio, Leah
Grace

6.38 lbs.

46 cm

33 cm

37.1 C

Taniola, Wella Joie C.

April 24,
2014
05:48 pm

General Santos City

Hospital

General Santos City

Hospital
083-3015866

Batoctoy

Male

Batoctoy, Ruffa
Jean

6.82 lbs.

48 cm

36 cm

36.0 C

Taniola, Wella Joie C.

04:00 pm

5.

General Santos City

Hospital

083-3015866

10:09 am

4.

Full name, Address of

the
Facility & Contact No.

083-3015866
Rosales

General Santos City

Hospital
083-3015866

Villacorte

Male

Villacorte,
Geraldine

Registered Nurse

6.6 lbs.

52 cm

33 cm

37.7 C

Taniola, Wella Joie C.

General Santos City

Hospital
083-3015866

Supervised by:
Clinical Instructor License No./ exp. Date

Signature

Hospital Case No.

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015
Arline J. Magan RN, RM
09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015
Arline J. Magan RN, RM
09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1401001030

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1403002742

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1404004040

1403002362

1403002595

6.

May 02, 2014

Masabio

Male

Masabio,
Jovelyn

6.38 lbs.

51 cm

32 cm

36.7 C

Taniola, Wella Joie C.

General Santos City

Hospital

07:43 pm
083-3015866

7.

May 08, 2014

Sobel

Male

Sobel, Melanie

6.6 lbs.

49 cm

34 cm

37.4 C

Taniola, Wella Joie C.

General Santos City

Hospital

09:19 pm
083-3015866

8.

May 23, 2014

Bensorto

Female

Bensorto,
Jimvic

6.16 lbs.

46 cm

31 cm

36.9 C

Taniola, Wella Joie C.

General Santos City

Hospital

04:57 pm
083-3015866

9.

May 23, 2014

Sabdullah

Female

Sabdullah,
Munirah

5.5 lbs.

50 cm

30 cm

37.1 C

Taniola, Wella Joie C.

General Santos City

Hospital

09:26 pm
083-3015866

10.

June 20,
2014

Lopez

Male

Lopez, Daniela

7.04 lbs.

51 cm

32 cm

37.3 C

Taniola, Wella Joie C.

08:20 am

11.

July 03, 2014

General Santos City

Hospital
083-3015866

Josoy

Female

Josoy, Jenny
Rose

5.28 lbs.

47 cm

32 cm

37.6 C

Taniola, Wella Joie C.

General Santos City

Hospital

09:36 am
083-3015866

12.

July 4, 2014

Sagad

Female

Sagad, Michel

6.16 lbs.

51 cm

32 cm

37.8 C

Taniola, Wella Joie C.

General Santos City

Hospital

08:54 pm
083-3015866

13.

July 04, 2014

Requilme

Male

Requilme,
Aileen Hazel

5.5 lbs.

47 cm

33 cm

37.0 C

Taniola, Wella Joie C.

General Santos City

Hospital

10:15 am
083-3015866

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1405004274

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1405004483

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1405004996

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1405005008

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1406005982

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1407006437

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1407006484

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1407006488

14.

July 19, 014

Pineda

Male

Pineda, Lovella

6.16 lbs.

43 cm

32 cm

36.6 C

Taniola, Wella Joie C.

General Santos City

Hospital

03:35 pm
083-3015866

15.

July 24, 2014

Lanubay

Female

Lanubay,
Shenna Mae

6.16 lbs.

50 cm

31 cm

36.2 C

Taniola, Wella Joie C.

General Santos City

Hospital

05:42pm
083-3015866

16.

July 26, 2014

Organiza

Female

Organiza,
Sarah May

6.38 bs.

49 cm

32 cm

36.6 C

Taniola, Wella Joie C.

General Santos City

Hospital

04:45 pm
083-3015866

17.

August 01,
2014

Damie

Male

Damie, Raipa

6.16 lbs.

53 cm

33 cm

36.3 C

Taniola, Wella Joie C.

11:11 am

18.

August 08,
2014

083-3015866

Escribano

Male

Escribano,
Jonezy

9.46 lbs.

54 cm

35 cm

36.2 C

Taniola, Wella Joie C.

07:10 pm

19.

August 17,
2014

August 22,
2014

General Santos City

Hospital
083-3015866

Alba

Female

Alba, Ellen

5.5 lbs.

48 cm

32 cm

37.2 C

Taniola, Wella Joie C.

04:45 pm

20.

General Santos City

Hospital

General Santos City

Hospital
083-3015866

Gonzaga

Male

Gonzaga,
Jessa

6.6 lbs.

49 cm

33 cm

09:50 am

35.3 C

Taniola, Wella Joie C.

General Santos City

Hospital
083-3015866

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1407006997

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1407007172

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1407007229

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1408007477

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1408007718

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1408008087

Arline J. Magan RN, RM

09325148837
License No. RN 0134411
Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

1408008261

Note: 1.) for graduate midwives: Supervision must be by qualified/ clinical instructor.
2.) Registered Midwifes/ Clinical Instructors who supervise the student midwives and the affix their signature in this form must be present a Certificate of Training on Intravenous 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.02735805 issued at General Santos City on March 11, 2013

Administering Officer or Notary Public

Affix
Doc. Stamp
(To be posted on the last
page)

PROFESSIONAL REGULATION COMMISSION

Manila
BOARD OF MIDWIFERY

CERTIFIED CORRECT:

Signature:_______________Date:___________

Records of Actual Intravenous Insertions

Please check if the Applicant is:
Graduate Midwife

Name of Applicant: TANIOLA, WELLA JOIE C.

No.

1.

Name and Address of

Patient

Abellano, Judy Ann

Case No.

1405004238

Zone 3, Block 5,
Barangay Fatima
Uhaw General Santos
City

2.

Inso, Noreen Grace

1407006414

Purok 5, Block 4,
Barangay Fatima
Uhaw General Santos
City

3.

Taborado, Dona Rose

1408008250

Purok 6 Poblacion
Maasim, Sarangani
Province

4.

Mantalaba, Joan
Purok Bag-o, Malalag
Poblacion Maitum,
Sarangani Province

1411011159

Registered Nurse

School: BROKENSHIRE COLLEGE SOCSKSARGEN INC.

Complete Diagnosis
(Gravida_Para_)

Date &
Time
Perfomed

Pregnancy Uterine Full Term in

labor delivered via Normal
Spontaneous Vaginal Delivery to a
male neonate in cephalic
presentation, 38 weeks Age of
Gestation, Gravida 1 Para 0

May 2,
2014
5:35 pm

Pregnancy Uterine Full Term in

labor delivered via Normal
Spontaneous Vaginal Delivery to a
male neonate in cephalic
presentation, 39 weeks and 5/7
days Age of Gestation, Gravida 1
Para 0

July 4,
2014
10:48 am

Pregnancy Uterine Full Term in

labor delivered via Normal
Spontaneous Vaginal Delivery to a
male neonate in cephalic
presentation, 38 weeks Age of
Gestation, Gravida 1 Para 0

August
22, 2014
8:05 am

Pregnancy Uterine Full Term in

labor delivered via Normal
Spontaneous Vaginal Delivery to a
female neonate in cephalic
presentation, 39 weeks Age of
Gestation, Gravida 1 Para 0

Nov. 13,
2014
8:04 am

Full name, Address of the Facililty &

Contact No.

General Santos City Hospital

083-3015866

Supervised By:
Printed Name &
Contact No.
Arline J. Magan

Position/
Designation
Clinical
Instructor

Signature

License No./ Exp. Date

License No. RN 0134411
Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

083-3015866

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

083-3015866

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

General Santos City Hospital

083-3015866

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

5.

Girvan, Jorfa

1412012042

Purok Malinawon,
Tuyan Malapatan
Sarangani Province

Pregnancy Uterine Full Term in

labor delivered via Normal
Spontaneous Vaginal Delivery to a
neonate in cephalic presentation,
39 weeks Age of Gestation, Gravida
1 Para 2

December
10, 2014
1:07 pm

General Santos City Hospital

083-3015866

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

Note: 1.) For graduate midwives: Supervision must be by qualified/ clinical instructor.
2.) Registered Midwifes/ Clinical Instructors who supervise the student midwives and the affix their signature in this form must be present a Certificate of Training on Intravenous 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.02735805 issued at General Santos City on March 11, 2013

Administering Officer or Notary Public

Affix
Doc. Stamp
(To be posted on the last
page)

PROFESSIONAL REGULATION COMMISSION

Manila
BOARD OF MIDWIFERY
Records of Actual Suturing of Perineal Lacerations

CERTIFIED CORRECT:

Signature:_______________Date:___________
Printed Name: Sersosa B. Aromin, RM,RN,MAN
Designation: Dean/Principal
Lic. No: RM 0027789 Exp. Date: 2/20/15
Lic. No: RN 0428561 EXP. Date: 2/28/16

Please check if the Applicant is:

Graduate Midwife

Registered Nurse

School: BROKENSHIRE COLLEGE SOCSKSARGEN INCORPORATED

Name of Applicant: TANIOLA, WELLA JOIE C.
No.

Name and Address of

Patient

Case
No.

Complete Diagnosis
(Gravida_Para_)

Date & Time

Perfomed

Full name, Address of the

Faculty & Contact No.

Supervised By:
Printed Name &
Contact No.

1.

Manza, Flordeliz

1407006
472

Full term male neonate 38 weeks AOG

G1 P1s

July 4, 2014
8:05 am

Purok Kalonlama
Kihan

2.

Abiso, Anacel

083-3015866

Ensomo, Rebecca
Calumpang, General
Santos City

Arline J. Magan

Clinical
Instructor

Signature

License No./ Exp. Date

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

1408008
236

Full term female neonate 39 weeks AOG

G1 P1

Tinago 9-B Dadiangas

South General Santos
City

3.

General Santos City Hospital

Position/ Designation

August 22,
2014
8:22 am

General Santos City Hospital

083-3015866

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

1409009
519

Full term male neonate 40 weeks G1 P1

September
25, 2014
1:05 pm

General Santos City Hospital

083-3015866

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

4.

Villarba, Madelyn

1410010
000

Full term male neonate 39 weeks AOG

G1 P1

Purok Balunto,
Labangal General
Santos City

5.

Estrada, Jovelyn

October 9,
2014
9:15 am

General Santos City Hospital

083-3015866

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

1411011
371

Full term male neonate 40 weeks AOG

G1 P1

Purok Santa Ana

Lucia, Pangyan Glan
Sarangani Province

November
19, 2014
12:30 pm

General Santos City Hospital

083-3015866

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

Note: 1.) For graduate midwives: Supervision must be by qualified/ clinical instructor.
2.) Registered Midwifes/ Clinical Instructors who supervise the student midwives and the affix their signature in this form must be present a Certificate of Training on Intravenous 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.02735805 issued at General Santos City on March 11, 2013

Administering Officer or Notary Public

Affix
Doc. Stamp
(To be posted on the last
page)

CERTIFIED CORRECT:

Signature:_______________Date:___________
Printed Name: Sersosa B. Aromin, RM,RN,MAN
Designation: Dean/Principal
Lic. No: RM 0027789 Exp. Date: 2/20/15

Lic. No: RN 0428561 EXP. Date: 2/28/16

PROFESSIONAL REGULATION COMMISSION

Manila
BOARD OF MIDWIFERY
Records of Assisted Deliveries
Please check if the Applicant is:
Graduate Midwife

Registered Nurse

School: BROKENSHIRE COLLEGE SOCSKSARGEN INCORPORATED

Name of Applicant: TANIOLA, WELLA JOIE C.
Name and Address of
the Patient

1.

Lagang, Mary Ann

Case No.

1401000787

Carcon Village Purok

13 Lagao, General
Santos City
2.

Hinuguin, Robelyn

1401000900

Valencia Alegria,
Sarangani Province
3.

Dingal, Emelyn

1403002334

Purok Magiting,
Townsite Buayan
General Santos City
4.

Delina, Gladys Maybel

1403002835

Malungon, Sarangani
Province

5.

Abellano, Judy Ann

Zone 3, Block 5,
Barangay Fatima
Uhaw General Santos
City

1405004238

Complete Diagnosis
(Gravida_Para_)

Date & Time

Performed

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a female
neonate in cephalic presentation, 38 weeks Age of
Gestation, Gravida 5 Para 4

January 22,
2014
10:59 pm

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a male
neonate in cephalic presentation, 41 weeks Age of
Gestation, Gravida 3 Para 2

January 26,
2014
5:30 pm

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a female
neonate in cephalic presentation, 40 weeks Age of
Gestation, Gravida 1 Para 0

March 4,
2014
7:56 am

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a male
neonate in cephalic presentation, 39 weeks and 4/7
days Age of Gestation, Gravida 1 Para 0

March 18,
2014
2:19 pm

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a male
neonate in cephalic presentation, 38 weeks Age of
Gestation, Gravida 1 Para 0

May 2, 2014
8:20 pm

Full name, Address of

the Facility & Contact
No.
General Santos City
Hospital

Supervised By:
Printed Name &
Contact No.
Arline J. Magan

Position/
Designation
Clinical
Instructor

Signature

License No./ Exp. Date

License No. RN 0134411
Expiry Date: November 15, 2015

09325148837
083-3015866
General Santos City
Hospital

License No. RM 0162958

Expiry Date: November 15, 2015
Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

Clinical
Instructor

License No. RM 0162958

Expiry Date: November 15, 2015
License No. RN 0134411
Expiry Date: November 15, 2015

09325148837
083-3015866
General Santos City
Hospital

Arline J. Magan
09325148837

083-3015866
General Santos City
Hospital

License No. RM 0162958

Expiry Date: November 15, 2015
Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
083-3015866

General Santos City

Hospital

License No. RM 0162958

Expiry Date: November 15, 2015
Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
083-3015866

License No. RM 0162958

Expiry Date: November 15, 2015

6.

Sese, Evelyn

1405004494

KPS Mabuhay,
General Santos City
7.

Taguding, Lovelyn
Mae

1406005956

Springville, Apopong
General Santos City
8.

Desaville, Evelyn

1406005988

Klinan 5, Mabuhay
General Santos City
9.

Inso, Noreen Grace

10.

Purok 5, Block 4,
Barangay Fatima
Uhaw General Santos
City
Sardido, Jesame

1407006414

1407007251

San Pedro Extension

Lagao, General
Santos City
11.

Albarida, Catherine

1408007820

Purok 7 Baluntay
Alabel, Sarangani
Province
12.

Taborado, Dona Rose

1408008250

Purok 6 Poblacion
Maasim Sarangani
Province
13.

Bantilan, Rehina

14.

Sitio Glamang, Datal

Anggas,Polomolok
South Cotabato
Revilla, Romielyn

1408008272

1410010038

Purok 4, Cogonal
Alabel Sarangani
Province
15.

Patcheo, Angelica
Purok Pantay-pantay,
Baluan General
Santos City

1411011147

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a male
neonate in cephalic presentation, 40 weeks and 4/7
days Age of Gestation, Gravida 4 Para 3

May 8, 2014
9:55 pm

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a male
neonate in cephalic presentation, 38 weeks Age of
Gestation, Gravida 1 Para 0

June 19, 2014

5:21 pm

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a male
neonate in cephalic presentation, 38 weeks and 5/7
days Age of Gestation, Gravida 3 Para 2

June 20, 2014

10:50 am

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a male
neonate in cephalic presentation, 39 weeks and 5/7
days Age of Gestation, Gravida 1 Para 0

July 4, 2014
3:25 pm

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a male
neonate in cephalic presentation, 38 weeks Age of
Gestation, Gravida 1 Para 0

July 26, 2014

6:33 pm

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a female
neonate in cephalic presentation,38 weeks and 4/7
days Age of Gestation, Gravida 4 Para 3

August 10,
2014
5:01 pm

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a male
neonate in cephalic presentation, 38 weeks Age of
Gestation, Gravida 1 Para 0

August 22,
2014
11:30 am

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a female
neonate in cephalic presentation, 38 weeks Age of
Gestation, Gravida 1 Para 0

August 22,
2014
4:20 pm

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a male
neonate in cephalic presentation, 38 weeks and 6/7
days Age of Gestation, Gravida 2 Para 1

October 10,
2014
9:08 am

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a male
neonate in cephalic presentation, 38 weeks Age of
Gestation, Gravida 1 Para 0

November 12,
2014
1:00 pm

General Santos City

Hospital

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
083-3015866
General Santos City
Hospital

License No. RM 0162958

Expiry Date: November 15, 2015
Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
083-3015866
General Santos City
Hospital

License No. RM 0162958

Expiry Date: November 15, 2015
Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

Clinical
Instructor

License No. RM 0162958

Expiry Date: November 15, 2015
License No. RN 0134411
Expiry Date: November 15, 2015

09325148837
083-3015866
General Santos City
Hospital

Arline J. Magan
09325148837

083-3015866
General Santos City
Hospital

License No. RM 0162958

Expiry Date: November 15, 2015
Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
083-3015866
General Santos City
Hospital

License No. RM 0162958

Expiry Date: November 15, 2015
Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
083-3015866
General Santos City
Hospital
083-3015866
General Santos City
Hospital

License No. RM 0162958

Expiry Date: November 15, 2015
Arline JerusalemMagan

Clinical
Instructor

09325148837
Arline J. Magan

License No. RN 0134411

Expiry Date: November 15, 2015
License No. RM 0162958
Expiry Date: November 15, 2015

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

Clinical
Instructor

License No. RM 0162958

Expiry Date: November 15, 2015
License No. RN 0134411
Expiry Date: November 15, 2015

09325148837
083-3015866
General Santos City
Hospital

Arline J. Magan
09325148837

083-3015866
General Santos City
Hospital

License No. RM 0162958

Expiry Date: November 15, 2015
Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
083-3015866

License No. RM 0162958

Expiry Date: November 15, 2015

16.

Obejero, Amy

1411011176

Purok 16, B-4 Fatima

General Santos City
17.

Mantalaba, Joan

1411011159

Purok Bag-o, Malalag

Poblacion, Maitum
Sarangani Province
18.

19.

20.

Girvan, Jorfa
Purok Malinawon,
Tuyan Malapatan,
Sarangani Province
Corompido, Rechelle
Mae
Crisostomo,
Calumpang General
Santos City
Balabagan, Arbaina

1412012042

1412012017

1501000211

Sarif Mucsin, Baluan

General Santos City

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a female
neonate in breech presentation, 38 weeks Age of
Gestation, Gravida 2 Para 3

November 13,
2014
8:44 am

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a female
neonate in cephalic presentation, 39 weeks Age of
Gestation, Gravida 1 Para 0

November 13,
2014
12:07 pm

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a female
neonate in cephalic presentation, 39 weeks Age of
Gestation, Gravida 1 Para 2

December 10,
2014
6:22 pm

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery t0 female
neonate in cephalic presentation, 39 weeks Age of
Gestation, Gravida 1 Para 0

December 11,
2014
12:53 pm

Pregnancy Uterine Full Term in labor delivered via

Normal Spontaneous Vaginal Delivery to a female
neonate in cephalic presentation, 39 weeks and 2/7
days Age of Gestation, Gravida 2 Para 1

January 7,
2015
1:40 pm

General Santos City

Hospital

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
083-3015866
General Santos City
Hospital

License No. RM 0162958

Expiry Date: November 15, 2015
Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
083-3015866
General Santos City
Hospital

License No. RM 0162958

Expiry Date: November 15, 2015
Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

Clinical
Instructor

License No. RM 0162958

Expiry Date: November 15, 2015
License No. RN 0134411
Expiry Date: November 15, 2015

09325148837
083-3015866
General Santos City
Hospital

Arline J. Magan
09325148837

083-3015866
General Santos City
Hospital

License No. RM 0162958

Expiry Date: November 15, 2015
Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
083-3015866

License No. RM 0162958

Expiry Date: November 15, 2015

Note: 1.) For graduate midwives: Supervision must be by qualified/ clinical instructor.
2.) Registered Midwifes/ Clinical Instructors who supervise the student midwives and the affix their signature in this form must be present a Certificate of Training on Intravenous 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.02735805 issued at General Santos City on March 11, 2013

Administering Officer or Notary Public

Affix
Doc. Stamp
(To be posted on the last
page)

CERTIFIED CORRECT:

Signature:_______________Date:___________
Printed Name: Sersosa B. Aromin, RM,RN,MAN
Designation: Dean/Principal
Lic. No: RM 0027789 Exp. Date: 2/20/15
Lic. No: RN 0428561 EXP. Date: 2/28/16

PROFESSIONAL REGULATION COMMISSION

Manila
BOARD OF MIDWIFERY
Records of Actual Intravenous Insertions
Please check if the Applicant is:
Graduate Midwife

Registered Nurse

School: BROKENSHIRE COLLEGE SOCSKSARGEN INC.

Name of Applicant: ENCARNACION, MARY JOY BAUTISTA
No.

1.

Name and Address of

Patient

Marites Malinao

Case No.

13060072
03

Look Basag South

Cotabato

2.

Irene Mendoza

13050050
81

Dambol palimbang
South Cotabato

3.

Majorie Ortiz

13060072
29

Roseville mabuhay
General Santos City

4.

Zosina Zaballero
Purok 5, Apopong
General Santos Cty

13060069
07

Complete Diagnosis
(Gravida_Para_)

Date &
Time
Perfomed

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous
Vaginal Delivery to a female neonate in
cephalic presentation, 39 week s day
Age of Gestation, Gravida 1 Para 0

June
27,2013
9:22am

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous
Vaginal Delivery to a female neonate in
cephalic presentation, 40 weeks 5 days
Age of Gestation, Gravida 2 Para 1

May
3,2013
9:am

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous
Vaginal Delivery to a male neonate in
cephalic presentation, 39 weeks Age of
Gestation, Gravida 1 Para 0

June
27,,2013
11:33am

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous
Vaginal Delivery to a female neonate in
cephalic presentation,36 weeks 1 day
Age of Gestation, Gravida 3 Para 2

June 19,
2013
9:46am

Full name, Address of the Facililty &

Contact No.

Brokenshire College SOCSKSARGEN

Inc. Lying-in Ced Avenue, National
Highway,
General Santos City
083-3049509

Brokenshire College SOCSKSARGEN

Inc. Lying-in Ced Avenue, National
Highway,
General Santos City
083-3049509

Brokenshire College SOCSKSARGEN

Inc. Lying-in Ced Avenue, National
Highway,
General Santos City
083-3049509
Brokenshire College SOCSKSARGEN
Inc. Lying-in Ced Avenue, National
Highway,
General Santos City
083-3049509

Check
If
Home
Del.

Supervised By:
Printed Name &
Contact No.
Arline J. Magan

Position/
Designation
Clinical
Instructor

Signature

License No./ Exp. Date

License No. RN 0134411
Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015
Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

5.

Dela Cruz, Jamila

01-0451

1st Brgy. Lagao

Crossing Conel
Sunga Farm General
Santos City

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous
Vaginal Delivery to a female neonate in
cephalic presentation, 39 weeks 5 days
Age of Gestation, Gravida 3 Para 3

October
4,2012
2:00am

Brokenshire College SOCSKSARGEN

Inc. Lying-in Ced Avenue, National
Highway,
General Santos City
083-3049509

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

Note: 1.) For graduate midwives: Supervision must be by qualified/ clinical instructor.
2.) Registered Midwifes/ Clinical Instructors who supervise the student midwives and the affix their signature in this form must be present a Certificate of Training on Intravenous 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.02735805 issued at General Santos City on March 11, 2013

Administering Officer or Notary Public

Affix
Doc. Stamp
(To be posted on the last
page)

CERTIFIED CORRECT:

Signature:_______________Date:___________
Printed Name: Sersosa B. Aromin, RM,RN,MAN
Designation: Dean/Principal
Lic. No: RM 0027789 Exp. Date: 2/20/15
Lic. No: RN 0428561 EXP. Date: 2/28/16

PROFESSIONAL REGULATION COMMISSION

Manila
BOARD OF MIDWIFERY
Records of Actual Suturing of Perineal Lacerations
Please check if the Applicant is:
Graduate Midwife

Registered Nurse

School: BROKENSHIRE COLLEGE SOCSKSARGEN INCORPORATED

Name of Applicant: ENCARNACION, MARY JOY BAUTISTA
No.

1.

Name and Address of

Patient

Calanao, Shina

Case
No.

01-0448

San Miguel
Calumpang
General Santos City

2.

Ronulo, Cherry Love

01-0455

Tiesa St. Dadiangas

North
General Santos City

3.

Manlaba, Tiny
Placida Brgy.
Calumpang
General Santos City

01-0456

Complete Diagnosis
(Gravida_Para_)

Date & Time

Perfomed

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous
Vaginal Delivery to a male neonate in
cephalic presentation, 38 weeks 2 days
Age of Gestation, Gravida 1 Para 1

February
4, 2012
7:40am

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous
Vaginal Delivery to a female neonate in
cephalic presentation, 39 week s 1 day
Age of Gestation, Gravida 1 Para 1

August
2, 2012
11:00pm

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous
Vaginal Delivery to a male neonate in
cephalic presentation, 37 weeks 5 days
Age of Gestation, Gravida 1 Para 1

August
13, 2012
4:30pm

Full name, Address of the

Faculty & Contact No.

Brokenshire College SOCSKSARGEN

Inc. Lying-in Ced Avenue, National
Highway,
General Santos City
083-3049509

Brokenshire College SOCSKSARGEN

Inc. Lying-in Ced Avenue, National
Highway,
General Santos City
083-3049509

Brokenshire College SOCSKSARGEN

Inc. Lying-in Ced Avenue, National
Highway,
General Santos City
083-3049509

Check
If
Home
Del.

Supervised By:
Printed Name &
Contact No.

Arline J. Magan

Position/
Designation

Clinical
Instructor

Signature

License No./ Exp. Date

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

4.

Magan, Mary Claire

01-0454

City Heights
General Santos City

5.

Angos, Ann
Prk. Wal, Brgy.
Tambler General
Santos City

01-0457

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous
Vaginal Delivery to a male neonate in
cephalic presentation, 40 weeks day
Age of Gestation, Gravida 1 Para 1

Pregnancy Uterine Full Term in labor

delivered via Normal Spontaneous
Vaginal Delivery to a female neonate in
cephalic presentation, 38 weeks 5 days
Age of Gestation, Gravida 1 Para 1

August
25,2012
12:30pm

September
24, 2012
11:pm

Brokenshire College SOCSKSARGEN

Inc. Lying-in Ced Avenue, National
Highway,
General Santos City
083-3049509

Brokenshire College SOCSKSARGEN

Inc. Lying-in Ced Avenue, National
Highway,
General Santos City
083-3049509

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

Arline J. Magan

Clinical
Instructor

License No. RN 0134411

Expiry Date: November 15, 2015

09325148837
License No. RM 0162958
Expiry Date: November 15, 2015

Note: 1.) For graduate midwives: Supervision must be by qualified/ clinical instructor.
2.) Registered Midwifes/ Clinical Instructors who supervise the student midwives and the affix their signature in this form must be present a Certificate of Training on Intravenous 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.02735805 issued at General Santos City on March 11, 2013

Administering Officer or Notary Public

Affix
Doc. Stamp
(To be posted on the last
page)

CERTIFIED CORRECT:

Signature:_______________Date:___________
Printed Name: Sersosa B. Aromin, RM,RN,MAN
Designation: Dean/Principal
Lic. No: RM 0027789 Exp. Date: 2/20/15
Lic. No: RN 0428561 EXP. Date: 2/28/16