NAME:

DATE:
BP:
Wt:

HISTORY:
Gravida____ Para _____
LMP:

FH:

EDD:

FHT:

AOG:

(TPAL)- ___-___-___-___
Medical Condition: (+/-)
( ) Asthma
( )
Allergies
( ) HPN
( )
DM
( ) Goiter
( )
PTB
( ) Cardiac Disorders
Tetanus Toxoid
Status:_________
HBsAg :
_____________________

SAFE MOTHERHOOD MATERNITY CLINIC

Contact no.: 0998 982 3953

CONTACT NUMBERS
Hospitals
Immaculate Hospital San Pablo City
San Pablo Doctors Hospital
Community General Hospital
San Pablo Medical Center
PPL (OB ward)
PPL (ER)
LPH (Sta. Cruz)
Batangas Provincial Hospital

Philippine General Hospital

National Childrens Hospital
Obstetrician-Gynecologist
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.

Aningalang
Angeles
Candido
Esclanda
Mamasig
Palami

Dr. Quiambao
Dr. Valdez

Number
(049) 562 5132
(049) 562 4069 / (049) 562 7910
(049) 562 8007 / (049) 561 2851
(049) 5613-193
(049) 562 4130
(049) 562 5259
(049) 543 3333
(043) 980 1743 / (043) 722 0812
(02) 554-8400/ (02)524-8484/ (02) 5218450
(632) 724-0656/(632) 724-0659
0928 363 5074
0917 314 6377
0915 577 3613
0916 284 7761
0920 908 4891 / 0922 849 0673
0915 275 1081 / 0921 505 6151 / 0933 991
4517
0919 398 2124
0917 599 3858

Pediatrician
Dr. Mamasig
Dr. Manalo

0920 908 4891 / 0922 849 0673

0908 884 1494

Nurse and Midwife

April D. Nool, RN
Criezl B. Arida, RN
Maria Annette Guevarra, RN
Herlene Lani S. Nool, RN
Marina D. Calingasan, RM
Rowella B. Averion, RN,RM
Jedy Ann Calingasan

0946 835 5386 / 0920 182 9158

09152498176
09169896507
09169230122
0939 916 2545 / 0905 390 4054
0908 866 7023
09067049461

Laboratories
DBD
Nolet Lab
PLM
Papsmear Lab

(049) 562 7263

0919 427 8390 / 0919 509 1198
0909 548 2354
0917 887 1596

Others
Abest
Oxygen Refill
Philhealth (Lucena)
Philhealth (San Pablo)

0947 935 3495

(049) 521 0659
(042) 710 9893 / (042) 373 6704
(049) 562 7027 / (049) 562 9242
SMMC