PROFESSIONAL REGULATION COMMISSION

Cebu
PRC FORM No. 106 BOARD OF MIDWIFERY
(Revised January 2011) Record of Actual Deliveries Handled
Please Check if Applicant is:
Graduate of Midwife Registered Nurse
Name of Applicant: ENRIQUEZ, IRIS G. School: BIT International College
Complete Diagnosis SUPERVISED BY:
Date & Time Full Name & Address of Facility & Check if
Name & Address of Patient Case No. (Gravida _para_) Home
Performed Contact Number Printed Name & Position/ Signature License No. &
Delivery Contact No. Designation Exp. Date

Pregnancy Uterine Full Term 39 6/7 wks 02/01/22 Bohol Lying-In Clinic Mrs. Ginesa
1. Fortugaliza, Grace L. 6798 AOG, delivered spontaneously alive baby CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Poblacion, Pilar, Bohol boy in cephalic presentation with an APGAR Bohol. 09655520543 Instructor August 25,2025
score of 9; G2P2; 4:14AM Tel. no. 09995985029

2. Octura, Mary Joyce A. Pregnancy Uterine Full Term 40 wks AOG, Bohol Lying-In Clinic Mrs. Ginesa
Dampas District, Tagbilaran City, 56247 delivered spontaneously alive baby boy in 02/03/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Bohol cephalic presentation with an APGAR score 4:05PM Bohol. 09655520543 Instructor August 25,2025
of 9; G2P2; Tel. no. 09995985029

Pregnancy Uterine Full Term 38 wks AOG, Bohol Lying-In Clinic Mrs. Ginesa
3. Palva, Nabel L. 56259 delivered spontaneously alive baby girl in 02/08/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
San Roque, Balilihan, Bohol cephalic presentation with an APGAR score 10:34AM Bohol. 09655520543 Instructor August 25,2025
of 9; G2P2; Tel. no. 09995985029

Pregnancy Uterine Full Term 40 wks AOG, Bohol Lying-In Clinic Mrs. Ginesa
4. Centino, Grace Lee R. Dipatlong, 56267 delivered spontaneously alive baby boy in 02/12/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Maribojoc, Bohol cephalic presentation with an APGAR score 5:33PM Bohol. 09655520543 Instructor August 25,2025
of 9; G3P3; Tel. no. 09995985029

Pregnancy Uterine Full Term 39 6/7 wks Bohol Lying-In Clinic Mrs. Ginesa
5. Balaba, Jennifer A. 56383 AOG, delivered spontaneously alive baby 02/26/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Delapaz,Cortes,Bohol girl in cephalic presentation with an APGAR 7:25PM Bohol. 09655520543 Instructor August 25,2025
score of 9; G2P2; Tel. no. 09995985029
 Pregnancy Uterine Full Term 39 1/7 wks Bohol Lying-In Clinic Mrs. Ginesa
6. Codero, Libeth Joy D. 56416 AOG, delivered spontaneously alive baby 03/18/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Aliguay, Maribojoc, Bohol boy in cephalic presentation with an APGAR 12:35PM Bohol. 09655520543 Instructor August 25,2025
score of 9; G3P3; Tel. no. 09995985029

7. Abne, Manelyn C. Pregnancy Uterine Full Term 39 5/7wks Bohol Lying-In Clinic Mrs. Ginesa
Baucan Sur, Balilihan, 56439 AOG, delivered spontaneously alive baby 04/07/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Bohol boy in cephalic presentation with an APGAR 5:03PM Bohol. 09655520543 Instructor August 25,2025
score of 9; G3P3; Tel. no. 09995985029

Pregnancy Uterine Full Term 40 wks AOG, Bohol Lying-In Clinic Mrs. Ginesa
8. Tongco, Floreane P 56447 delivered spontaneously alive baby girl in 04/15/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Tupas, Antiquera, Bohol cephalic presentation with an APGAR score 8:44AM Bohol. 09655520543 Instructor August 25,2025
of 9; G2P2; Tel. no. 09995985029

9. Sevilla, Judelyn M Pregnancy Uterine Full Term 39 wks AOG, Bohol Lying-In Clinic Mrs. Ginesa
Candaigan, Loon, 56449 delivered spontaneously alive baby boy in 04/16/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Bohol cephalic presentation with an APGAR score 5:12PM Bohol. 09655520543 Instructor August 25,2025
of 9; G2P2; Tel. no. 09995985029

10. Remetado, Jove Mae M Pregnancy Uterine Full Term 39 wks AOG, Bohol Lying-In Clinic Mrs. Ginesa
Poblacion Ondol, Loboc, Bohol 56455 delivered spontaneously alive baby girl in 04/19/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
cephalic presentation with an APGAR score 9:16PM Bohol. 09655520543 Instructor August 25,2025
of 9; G2P2; Tel. no. 09995985029

Pregnancy Uterine Full Term 40 wks AOG, Bohol Lying-In Clinic Mrs. Ginesa
11. Tuizo, Dally Mary L 56483 delivered spontaneously alive baby boy in 05/15/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Rosario, Cortes, Bohol cephalic presentation with an APGAR score 8:00PM Bohol. 09655520543 Instructor August 25,2025
of 9; G2P2; Tel. no. 09995985029

12. Asuque, Karen M Pregnancy Uterine Full Term 38 5/7 wks Bohol Lying-In Clinic Mrs. Ginesa
Kinabag-an, 56526 AOG, delivered spontaneously alive baby 06/21/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Calape, Bohol boy in cephalic presentation with an APGAR 4:06AM Bohol. 09655520543 Instructor August 25,2025
score of 9; G2P2; Tel. no. 09995985029
 Pregnancy Uterine Full Term 38 2/7 wks Bohol Lying-In Clinic Mrs. Ginesa
13. Afable, Edna Q 5858 AOG, delivered spontaneously alive baby 09/16/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Launion, Candijay, Bohol boy in cephalic presentation with an APGAR 8:19AM Bohol. 09655520543 Instructor August 25,2025
score of 9; G3P3; Tel. no. 09995985029

Pregnancy Uterine Full Term 39 6/7 wks Bohol Lying-In Clinic Mrs. Ginesa
14. Orapa, Virgenia M 56688 AOG, delivered spontaneously alive baby 10/01/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Zamora, Bilar, Bohol boy in cephalic presentation with an APGAR 5:55PM Bohol. 09655520543 Instructor August 25,2025
score of 9; G2P2; Tel. no. 09995985029

15. Lajot, Innesa S Pregnancy Uterine Full Term 40 4/7 wks Bohol Lying-In Clinic Mrs. Ginesa
Dampas 56698 AOG, delivered spontaneously alive baby 10/05/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
District, Tagbilaran City, Bohol boy in cephalic presentation with an APGAR 1:26PM Bohol. 09655520543 Instructor August 25,2025
score of 9; G3P3; Tel. no. 09995985029

16. Silva, Mary Joy L Pregnancy Uterine Full Term 38 wks AOG, Bohol Lying-In Clinic Mrs. Ginesa
Booy 56732 delivered spontaneously alive baby boy in 11/12/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
District,Tagbilaran City,Bohol cephalic presentation with an APGAR score 2:58PM Bohol. 09655520543 Instructor August 25,2025
of 9; G3P3; Tel. no. 09995985029

Pregnancy Uterine Full Term 38 wks AOG, Bohol Lying-In Clinic Mrs. Ginesa
17. Sultan, Jalela M. 56736 delivered spontaneously alive baby girl in 11/18/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Camambugan, Ubay, Bohol cephalic presentation with an APGAR score 2:00AM Bohol. 09655520543 Instructor August 25,2025
of 9; G2P2; Tel. no. 09995985029

Pregnancy Uterine Full Term 38 wks AOG, Bien Unido Mho Birthing Center Mrs. Ginesa
18. Pacaldo, Cara 1570 delivered spontaneously alive baby girl in 12/09/22 Poblacion,Bien Unido,Bohol 6326 Tel. Cagampang Clinical 0076491
Malingin,Bien Unido,Bohol cephalic presentation with an APGAR score 11:15PM no. 09088678712 09655520543 Instructor August 25,2025
of 9; G2P2;

Pregnancy Uterine Full Term 38 wks AOG, Bien Unido Mho Birthing Center Mrs. Ginesa
19.Lacosta, Rhea 1579 delivered spontaneously alive baby girl in 12/27/22 Poblacion, Bien Unido, Bohol. Cagampang Clinical 0076491
Poblacion, Bien Unido, Bohol cephalic presentation with an APGAR score 6:05AM Tel. no. 09655520543 Instructor August 25,2025
of 9; G2P2; 09088678712
20. Caga-anan, Arlene Pregnancy Uterine Full Term 39 wks AOG, Rural Health Unit 1 Birthing Center Mrs. Ginesa
Marawi, Valencia, 818 delivered spontaneously alive baby boy in 04/11/23 Poblacion Occidental, Cagampang Clinical 0076491
Bohol cephalic presentation with an APGAR score 11:46PM Valencia, Bohol. 09655520543 Instructor August 25,2025
of 9; G2P2; Tel. no. (038) 422 0308

Notes: 1.) For graduate midwives. Supervision must be by qualified faculty/clinical instructor.
2.) Registered midwives/clinical instructor who supervise the student midwives and affix their signatures in this Form must present a certificate of training on Actual Deliveries Handled 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 ____________ on _____________.

CERTIFIED CORRECT:
Signature: ________________ Date: ______________
Printed Name: Ms. Leah Virginia Balite-Lim
Designation: PRINCIPAL
Administrative Officer of Notary Public Lic. No. 0106218 Expiry: __________________
 PROFESSIONAL REGULATION COMMISSION
CEBU CITY
PRC FORM No. 106 BOARD OF MIDWIFERY
(Revised January 2011)
Record of Conducted Actual Internal Examination Before Delivery
Please Check if Applicant is:
Graduate of Midwife Registered Nurse
Name of Applicant: ENRIQUEZ, IRIS G. School: BIT International College
Complete Diagnosis SUPERVISED BY:
Date & Time Full Name & Address of Facility & Check if
Name & Address of Patient Case No. (Gravida _para_) Home
Performed Contact Number Printed Name & Position/ Signature License No. &
Delivery Contact No. Designation Exp. Date

G2P2, 30 y,o., Pregnancy Uterine 39 6/7 02/01/22 Bohol Lying-In Clinic Mrs. Ginesa
1. Fortugaliza, Grace L. 6798 wks Age Of Gestation, Cephalic in labor, CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Poblacion, Pilar, Bohol 9cm Dilated Cervix, 80% Effaced, Station 2:14AM Bohol. 09655520543 Instructor August 25,2025
+1, Ruptured Bag of Water (Clear) Tel. no. 09995985029

2. Octura, Mary Joyce A. G3P3; 24 y,o., Pregnancy Uterine 40 wks Bohol Lying-In Clinic Mrs. Ginesa
Dampas District,Tagbilaran City, 56247 Age Of Gestation, Cephalic in labor, 9cm 02/03/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Bohol Dilated Cervix, 80% Effaced, Station +1, 2:10PM Bohol. 09655520543 Instructor August 25,2025
Ruptured Bag of Water (Clear) Tel. no. 09995985029

G2P2; 34 y,o., Pregnancy Uterine 38 wks Bohol Lying-In Clinic Mrs. Ginesa
3. Palva, Nabel L. 56259 Age Of Gestation, Cephalic in labor, 9cm 02/08/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
San Roque, Balilihan, Bohol Dilated Cervix, 90% Effaced, Station +2, 8:30AM Bohol. 09655520543 Instructor August 25,2025
Ruptured Bag of Water (Clear) Tel. no. 09995985029

G3P3, 32 y,o., Pregnancy Uterine 40 wks Bohol Lying-In Clinic Mrs. Ginesa
4. Centino, Grace Lee R. Dipatlong, 56267 Age Of Gestation, Cephalic in labor, 9cm 02/12/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Maribojoc, Bohol Dilated Cervix, 90% Effaced, Station +2, 3:30PM Bohol. 09655520543 Instructor August 25,2025
Ruptured Bag of Water (Clear) Tel. no. 09995985029

G2P2, 30 y,o., Pregnancy Uterine 39 6/7 Bohol Lying-In Clinic Mrs. Ginesa
5. Balaba, Jenniper A. 56383 wks Age Of Gestation, Cephalic in labor, 02/26/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Delapaz,Cortes,Bohol 10cm Dilated Cervix, 100% Effaced, Station 5:25PM Bohol. 09655520543 Instructor August 25,2025
+3, Ruptured Bag of Water (Clear) Tel. no. 09995985029
 G3P3, 33 y,o., Pregnancy Uterine 39 1/7 Bohol Lying-In Clinic Mrs. Ginesa
6. Codero, Libeth Joy D. 56416 wks Age Of Gestation, Cephalic in labor, 03/18/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Aliguay, Maribojoc, Bohol 9cm Dilated Cervix, 80% Effaced, Station 10:35PM Bohol. 09655520543 Instructor August 25,2025
+1, Ruptured Bag of Water (Clear) Tel. no. 09995985029

7. Abne, Manelyn C. G3P3, 30 y,o., Pregnancy Uterine 39 5/7 Bohol Lying-In Clinic Mrs. Ginesa
Baucan Sur, Balilihan, 56439 wks Age Of Gestation, Cephalic in labor, 04/07/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Bohol 9cm Dilated Cervix, 80% Effaced, Station 3:10PM Bohol. 09655520543 Instructor August 25,2025
+1, Ruptured Bag of Water (Clear) Tel. no. 09995985029

G2P2, 29 y,o., Pregnancy Uterine 40 wks Bohol Lying-In Clinic Mrs. Ginesa
8. Tongco, Floreane P 56447 Age Of Gestation, Cephalic in labor, 10cm 04/15/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Tupas, Antiquera, Bohol. Dilated Cervix, 80% Effaced, Station +2, 6:45AM Bohol. 09655520543 Instructor August 25,2025
Ruptured Bag of Water (Clear) Tel. no. 09995985029

G2P2, 31 y,o., Pregnancy Uterine 39 wks Bohol Lying-In Clinic Mrs. Ginesa
9. Sevilla, Judelyn M 56449 Age Of Gestation, Cephalic in labor, 9cm 04/16/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Candaigan, Loon, Bohol. Dilated Cervix, 80% Effaced, Station +1, 3:10PM Bohol. 09655520543 Instructor August 25,2025
Ruptured Bag of Water (Clear) Tel. no. 09995985029

10. Remetado, Jove Mae M G2P2, 29 y,o., Pregnancy Uterine 39 wks Bohol Lying-In Clinic Mrs. Ginesa
Poblacion Ondol, Loboc, Bohol 56455 Age Of Gestation, Cephalic in labor, 9cm 04/19/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Dilated Cervix, 80% Effaced, Station +1, 7:00PM Bohol. 09655520543 Instructor August 25,2025
Ruptured Bag of Water (Clear) Tel. no. 09995985029

G2P2, 34 y,o.,Pregnancy Uterine 40wks Bohol Lying-In Clinic Mrs. Ginesa

11. Tuizo, Dally Mary L 56483 Age Of Gestation, Cephalic in labor, 10cm 05/15/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Rosario, Cortes, Bohol Dilated Cervix,100% Effaced, Station 6:00PM Bohol. 09655520543 Instructor August 25,2025
+2,Ruptured Bag of Water (Clear) Tel. no. 09995985029

12. Asuque, Karen M G2P2, 31 y,o., Pregnancy Uterine 38 5/7 Bohol Lying-In Clinic Mrs. Ginesa
Kinabagan, 56526 wks Age Of Gestation, Cephalic in labor, 06/21/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Calape, Bohol 9cm Dilated Cervix, 80% Effaced, Station 2:00AM Bohol. 09655520543 Instructor August 25,2025
+1, Ruptured Bag of Water (Clear) Tel. no. 09995985029

G3P3, 32 y,o., Pregnancy Uterine 38 2/7 Bohol Lying-In Clinic Mrs. Ginesa
13. Afable, Edna Q 5858 wks Age Of Gestation, Cephalic in labor, 09/16/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Launion, Candijay, Bohol 9cm Dilated Cervix, 90% Effaced, Station 6:00AM Bohol. 09655520543 Instructor August 25,2025
+1, Ruptured Bag of Water (Clear) Tel. no. 09995985029
 G2P2, 34 y,o., Pregnancy Uterine 39 6/7 Bohol Lying-In Clinic Mrs. Ginesa
14. Orapa, Virgenia M 56688 wks Age Of Gestation, Cephalic in labor, 10/01/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Zamora, Bilar, Bohol 9cm Dilated Cervix, 80% Effaced, Station 3:45PM Bohol. 09655520543 Instructor August 25,2025
+1, Ruptured Bag of Water (Clear) Tel. no. 09995985029

15. Lajot, Innesa S G3P3, 31 y,o., Pregnancy Uterine 40 4/7 Bohol Lying-In Clinic Mrs. Ginesa
Dampas 56698 wks Age Of Gestation, Cephalic in labor, 10/05/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
District,Tagbilaran City, Bohol 10cm Dilated Cervix, 100% Effaced, Station 11:20AM Bohol. 09655520543 Instructor August 25,2025
+3, Ruptured Bag of Water (Clear) Tel. no. 09995985029

16. Silva, Mary Joy L G3P3, 34 y,o., Pregnancy Uterine 38 wks Bohol Lying-In Clinic Mrs. Ginesa
Booy District,Tagbilaran 56732 Age Of Gestation, Cephalic in labor, 10cm 11/12/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
City, Bohol Dilated Cervix, 90% Effaced, Station +2, 12:58PM Bohol. 09655520543 Instructor August 25,2025
Ruptured Bag of Water (Clear) Tel. no. 09995985029

G2P2, 21 y,o., Pregnancy Uterine 38 wks Bohol Lying-In Clinic Mrs. Ginesa
17. Sultan, Jalela S 56736 Age Of Gestation, Cephalic in labor, 9cm 11/17/22 CPG East Avenue Tagbilaran City, Cagampang Clinical 0076491
Camambugan, Ubay, Bohol. Dilated Cervix, 70% Effaced, Station +1, 11:45AM Bohol. 09655520543 Instructor August 25,2025
Ruptured Bag of Water (Clear) Tel. no. 09995985029

G2P2, 19 y,o., Pregnancy Uterine 38 wks Bien Unido Mho Birthing Center Mrs. Ginesa
18. Pacaldo, Cara 1570 Age Of Gestation, Cephalic in labor, 10cm 12/09/22 9:15PM Poblacion,Bien Unido,Bohol 6326 Tel. Cagampang Clinical 0076491
Malingin,Bien Unido,Bohol Dilated Cervix, 100% Effaced, Station +2, no. 09088678712 09655520543 Instructor August 25,2025
Ruptured Bag of Water (Clear)

G2P2, 21 y,o., Pregnancy Uterine 38 wks Bien Unido Mho Birthing Center Mrs. Ginesa
19. Lacosta, Rhea 1579 Age Of Gestation, Cephalic in labor, 10cm 12/27/22 4:15AM Poblacion,Bien Unido,Bohol 6326 Tel. Cagampang Clinical 0076491
Poblacion, Bien Unido, Bohol Dilated Cervix, 100% Effaced, Station +2, no. 09088678712 09655520543 Instructor August 25,2025
Ruptured Bag of Water (Clear)

G2P2, 22 y,o., Pregnancy Uterine 39 wks Rural Health Unit 1 Birthing Center Mrs. Ginesa
20. Caga-anan, Arlene 818 Age Of Gestation, Cephalic in labor, 9cm 04/11/23 Poblacion Occidental, Cagampang Clinical 0076491
Marawi, Valencia, Bohol Dilated Cervix, 90% Effaced, Station +2, 9:30PM Valencia, Bohol. 09655520543 Instructor August 25,2025
Ruptured Bag of Water (Clear) Tel. no. (038) 422 0308

Notes: 1.) For graduate midwives. Supervision must be by qualified faculty/clinical instructor.
2.) Registered midwives/clinical instructor who supervise the student midwives and affix their signatures in this Form must present a certificate of training on Actual Deliveries Handled 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 ____________ on _____________.
 CERTIFIED CORRECT:
Signature: ________________ Date: ______________
Printed Name: Ms. Leah Virginia Balite-Lim
Designation: PRINCIPAL
Administrative Officer of Notary Public Lic. No. 0106218 Expiry: __________________
 PROFESSIONAL REGULATION COMMISSION
Cebu
PRC FORM No. 106 BOARD OF MIDWIFERY
(Revised January 2011) Record of Actual Intravenous Insertion
Please Check if Applicant is:
Graduate of Midwife Registered Nurse
Name of Applicant: ENRIQUEZ, IRIS G. School: BIT International College
Complete Diagnosis SUPERVISED BY:
Date & Time Full Name & Address of Facility & Check if
Name & Address of Patient Case No. (Gravida _para_) Home
Performed Contact Number Printed Name & Position/ Signature License No. &
Delivery Contact No. Designation Exp. Date

Pregnancy Uterine Full Term 40 wks AOG, Bohol Lying-In Clinic

CPG East Avenue, Tagbilaran City, Mrs. Ginesa
1. Señal, Rhea Darlene Del 56463 delivered spontaneously alive baby boy in cephalic 04/25/22 Cagampang Clinical
Carmen Este, Balilihan, Bohol. presentation with an APGAR score of 9; G2P2; IV 12:10AM Bohol Instructor
inserted due to prolonged labor. Tel. no. 09995985029 09655520543
0076491
August 25,2025

Pregnancy Uterine Full Term 39 4/7 wks AOG, Bohol Lying-In Clinic
CPG East Avenue, Tagbilaran City, Mrs. Ginesa
2. Gamus, Jechelle Marie 56467 delivered spontaneously alive baby girl in cephalic 04/30/22 Cagampang Clinical
Tiptip District, Tagbilaran City, Bohol. presentation with an APGAR score of 9; G2P2; IV 1:48PM Bohol 09655520543
Instructor
inserted due to leaking bag of water. Tel. no. 09995985029
0076491
August 25,2025

Pregnancy Uterine Full Term 39 wks AOG, Bohol Lying-In Clinic

3. Agosto, Jennifer CPG East Avenue, Tagbilaran City, Mrs. Ginesa
Cogon District,Tagbilaran City, 56469 delivered spontaneously alive baby boy in cephalic 05/01/22 Cagampang Clinical
Bohol presentation with an APGAR score of 9; G2P2; IV 2:24AM Bohol 09655520543
Instructor
inserted due to prolonged labor. Tel. no. 09995985029
0076491
August 25,2025

Pregnancy Uterine Full Term 39 wks AOG, Bohol Lying-In Clinic Mrs. Ginesa
4, Campion, Aires delivered spontaneously alive baby girl in cephalic 06/03/22 CPG East Avenue, Tagbilaran City, Clinical
Taloto District,Tagbilaran City, 5702 Cagampang
Bohol presentation with an APGAR score of 9; G2P2; IV 5:30AM Bohol 09655520543
Instructor
inserted due to leaking bag of water. Tel. no. 09995985029
0076491
August 25,2025

Pregnancy Uterine Full Term 40 wks AOG, Bohol Lying-In Clinic Mrs. Ginesa
5. Salvatiarra, Madel delivered spontaneously alive baby boy in cephalic 08/05/22 CPG East Avenue, Tagbilaran City, Cagampang Clinical
Basak Taloto, Tagbilaran City, Bohol 56588 presentation with an APGAR score of 9; G2P2; IV 12:25PM Bohol Instructor
inserted due to leaking bag of water. Tel. no. 09995985029 09655520543
0076491
August 25,2025
Notes: 1.) For graduate midwives. Supervision must be by qualified faculty/clinical instructor.
 2.) Registered midwives/clinical instructor who supervise the student midwives and affix their signatures in this Form must present a certificate of training on Actual Deliveries Handled 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 ____________ on _____________.

CERTIFIED CORRECT:
Signature: ________________ Date: ______________
Printed Name: Ms. Leah Virginia Balite-Lim
Designation: PRINCIPAL
Administrative Officer of Notary Public Lic. No. 0106218 Expiry: __________________
 PROFESSIONAL REGULATION COMMISSION
CEBU CITY
BOARD OF MIDWIFERY
PRC FORM No. 106 Record of Actual Suturing of Perineal Lacerations
(Revised January 2011)
Please Check if Applicant is:
Graduate of Midwife Registered Nurse
Name of Applicant: ENRIQUEZ, IRIS G. School: BIT International College
Complete Diagnosis SUPERVISED BY:
Date & Time Full Name & Address of Facility & Check if
Name & Address of Patient Case No. (Gravida _para_) Home
Performed Contact Number Printed Name & Position/ Signature License No. &
Delivery Contact No. Designation Exp. Date

Pregnancy Uterine Full Term 39 6/7 wks AOG, Bohol Lying-In Clinic Mrs. Ginesa
1. Baliog, Marissa 56616 delivered spontaneously alive baby boy in CPG East Avenue, Tagbilaran City, Clinical 0076491
Canlasid, Loboc, Bohol. cephalic presentation with an APGAR score of 08/16/22 8:50PM Bohol Cagampang
09655520543 Instructor August 25,2025
9; G2P2; First degree laceration repaired. Tel. no. 09995985029

Pregnancy Uterine Full Term 38 wks AOG, Bohol Lying-In Clinic Mrs. Ginesa
2. Gamo, Jolina 56781 delivered spontaneously alive baby boy in 12/02/22 CPG East Avenue, Tagbilaran City, Cagampang Clinical 0076491
Dampas, Tagbilaran City, Bohol cephalic presentation with an APGAR score of 10:55AM Bohol 09655520543 Instructor August 25,2025
9; G2P2; First degre laceration repaired. Tel. no. 09995985029

Pregnancy Uterine Full Term 40 wks AOG, Bohol Lying- In Clinic Mrs. Ginesa
3. Sarsonas, Mirasol 56779 delivered spontaneously alive baby boy in CPG East Avenue, Tagbilaran City, Clinical 0076491
Bingag, Dauis, Bohol. cephalic presentation with an APGAR score of 01/25/23 9:02PM Bohol Cagampang
09655520543 Instructor August 25,2025
9; G2P2; First degree laceration repaired. Tel. no. 09995985029

Pregnancy Uterine Full Term 40 wks AOG, Rural Health Unit 1 Birthing Center Mrs. Ginesa
4. Gamalo, Rudy Jean 790 delivered spontaneously alive baby girl in 8:57AM Valencia, Bohol. Poblacion Occidental, Clinical 0076491
Tausion, Valencia, Bohol. cephalic presentation with an APGAR score of 01/28/23 Cagampang
09655520543 Instructor August 25,2025
9; G2P2; First degree laceration repaired. Tel. no. (038) 422 0308

Pregnancy Uterine Full Term 39 wks AOG, Rural Health Unit 1 Birthing Center Mrs. Ginesa
5. Salise, Marites 796 delivered spontaneously alive baby girl in 02/12/23 Poblacion Occidental, Cagampang Clinical 0076491
Magsaysay, Valencia, Bohol. cephalic presentation with an APGAR score of 10:00AM Valencia, Bohol. 09655520543 Instructor August 25,2025
9; G2P2; First degree laceration repaired. Tel. no. (038) 422 0308

Notes: 1.) For graduate midwives. Supervision must be by qualified faculty/clinical instructor.
2.) Registered midwives/clinical instructor who supervise the student midwives and affix their signatures in this Form must present a certificate of training on Actual Deliveries Handled 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 ____________ on _____________.

CERTIFIED CORRECT:
Signature: ________________ Date: ______________
Printed Name: Ms. Leah Virginia Balite-Lim
Designation: PRINCIPAL
Administrative Officer of Notary Public Lic. No. 0106218 Expiry: __________________