Professional Documents
Culture Documents
106
(Revised October 2010)
Name of Applicant:
JONETH D. DE VERA
Case No.
4639
4694
4718
4768
4786
4924
7. Fe Asetre Aluzay
4930
4887
9. Cyril Paat
4889
4893
Compete Diagnosis
(Gravida_Para_)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G5P5 (5005)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G3P3 (3003)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G3P3 (3003)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G8P8 (8008)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G2P2 (2002)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G2P2 (2002)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G1P1 (1001)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G3P3 (3003)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G2P2 (2002)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G1P1 (1001)
School:
Registered Nurse
Check
Full Name, Address of
if
Facility & Contact
Home Printed Name &
Number
Del.
Contact No.
Supervised By:
Position/
Designation
Signature
License No. /
Exp. Date
09-24-05
8:10am
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
09-25-05
4:45am
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
09-28-05
6:00am
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
10-04-05
4:50am
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
10-08-05
6:00pm
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
10-27-05
7:00am
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
10-27-05
12:00pm
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
10-22-05
1:45am
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
10-22-05
11:00am
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
10-23-05
6:30am
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
Case No.
4910
4948
4965
4975
5002
5003
5017
5094
5077
5086
Note:
Compete Diagnosis
(Gravida_Para_)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G1P1 (1001)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G9P9 (9009)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G1P1 (1001)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G2P2 (2002)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G1P1 (1001)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G4P4 (4004)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G4P4 (4004)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G2P2 (2002)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G2P2 (2002)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G6P6 (6006)
Check
Full Name, Address of
if
Facility & Contact
Home Printed Name &
Number
Del.
Contact No.
Supervised By:
Position/
Designation
Signature
License No. /
Exp. Date
10-25-05
9:00am
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
11-01-05
2:00pm
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
11-09-05
6:00am
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
11-05-05
3:00am
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
11-09-05
8:35pm
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
11-10-05
9:45pm
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
11-11-05
11:35pm
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
11-14-05
8:00pm
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
11-20-05
10:10am
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
11-22-05
12:00am
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
CERTIFIED CORRECT:
____ at ____________________ Affiant exhibiting to me his/her Residence Certificate No. ____________ Issued at ________________
A F F I X
Documentary Stamp
(to be posted on the page)
on _________________.
Signature: Date:
Printed Name: EVANGELINE F. DOTILLOS RM, RN, MAN
Designation:
OIC/Principal of Midwifery
License Number: RN 0657024
Expiry Date: 9/23/16
RM 0147922
Expiry Date: 9/23/16
Name of Applicant:
JONETH D. DE VERA
1. Madelyn P. Dantes
San Antonio, San Jose
2. Cynthia N. Rizola
Omato, Lagonoy
3. Merly C. MIzamis
Tabgon, Goa
4. Laylin S. Milante
Loho, Lagonoy
5. Gina Capuz Sabado
San Jose
Note:
Case No.
Compete Diagnosis
(Gravida_Para_)
School:
Registered Nurse
Check
Full Name, Address of
if
Facility & Contact
Home
Number
Del. Printed Name &
Contact No.
Supervised By:
Position/
Designation
Signature
License No. /
Exp. Date
5157
12-04-05
12:00pm
Jovenal L. Peaflorida,
MD
Clinical
Instructor
MD: 0042804
Exp: Nov. 27, 2016
5160
12-16-05
10:00pm
Jovenal L. Peaflorida,
MD
Clinical
Instructor
MD: 0042804
Exp: Nov. 27, 2016
5143
12-20-05
1:30pm
Jovenal L. Peaflorida,
MD
Clinical
Instructor
MD: 0042804
Exp: Nov. 27, 2016
5058
12-03-05
1:00pm
Jovenal L. Peaflorida,
MD
Clinical
Instructor
MD: 0042804
Exp: Nov. 27, 2016
5026
12-19-05
11:00am
Jovenal L. Peaflorida,
MD
Clinical
Instructor
MD: 0042804
Exp: Nov. 27, 2016
Name of Applicant:
JONETH D. DE VERA
Case No.
1. Herson I. Plaero
Lamon Goa, Camarines Sur
5131
2. Arnel R. Primo
San Isidro
5132
3. Andro P. Rodriguez
Bag. Grande
5136
4. Tames D. Rimando
San Isidro
5120
5. Nena B. Pacis
Balaynan
5069
Note:
Compete Diagnosis
(Gravida_Para_)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G2P2 (2002)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G2P2 (2002)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G2P2 (2002)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G2P2 (2002)
Pregnancy Uterine Delivered
NSD with RMLE full term,
Cephalic,Episiorrhaphy Done
G1P1 (1001)
School:
Registered Nurse
Check
Full Name, Address of
if
Facility & Contact
Home Printed Name &
Number
Del.
Contact No.
Supervised By:
Position/
Designation
Signature
License No. /
Exp. Date
10-02-05
7:10pm
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
10-08-05
7:20pm
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
11-21-05
7:00pm
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
11-21-05
12:00am
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
12-07-05
9:00am
Severa R. Lanuzo, RM
09982507875
Clinical
Instructor
RM: 00117577
Exp: May 5, 2016
CERTIFIED CORRECT:
____ at ____________________ Affiant exhibiting to me his/her Residence Certificate No. ____________ Issued at ________________
A F F I X
Documentary Stamp
(to be posted on the page)
on _________________.
Signature: Date:
Printed Name: EVANGELINE F. DOTILLOS RM, RN, MAN
Designation:
OIC/Principal of Midwifery
License Number: RN 0657024
Expiry Date: 9/23/16
RM 0147922
Expiry Date: 9/23/16