INSTITUTIONAL ETHICAL APPROVAL FORM
FOR UNDERGRADUATE MEDICAL RESEARCH, PRIME FOUNDATION
(Peshawar Medical College, Peshawar Dental College, Rufaidah Nursing College)
CONFIDENTIAL
Institutional Ethical Approval Form
Important Note: This form should be completed and returned by email to
Secretary Institutional Ethics Committee at least one week before the
expected date of execution of the research project. Please submit two hard
copies as well.
1. Title of the project:
2. Name of Principal investigator and class:
3. Names of Co investigator(s) and class (not more than five):
i.
.............................................
ii.
.............................................
4. ............................................ Institution / Department:
5. Name of the Head of the Department:
6. Name and qualification of Supervisor:
7. Project summary:
Objectives:
Methods:
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INSTITUTIONAL ETHICAL APPROVAL FORM
FOR UNDERGRADUATE MEDICAL RESEARCH, PRIME FOUNDATION
(Peshawar Medical College, Peshawar Dental College, Rufaidah Nursing College)
8. Will the project involve human subjects?
Yes / No
.
9. Will the study involve special population like involvement of children,
pregnant women, physical / mental handicapped, prisoners and or any
other vulnerable population? If yes please mention the group
10. What are the expected number of participant(s):
11. How would you obtain the consent of the participant? (attach a copy of
consent form if applicable)
12. What steps have you taken to keep the data confidential (see form
XXXX)?
13. Is there any potential harm to the participant? If yes, what steps would you
take to minimize the harm?
14. Is there any potential benefit to the participant? If yes please describe
Important Note: Please note that any change in the project for any reason,
leading to any modification in the project objectives / methods etc shall be
notified to the IEC. In such cases resubmission for fresh ethical approval of
the project will be required.
The IEC shall be informed in writing if the project is discontinued for any
reason, along with the reasons of discontinuation.
In cases of joint venture with other organisations / institutions, ethical approval
of the IEC of PRIME Foundation will still be required, even if the IEC of the
other organization / institution has already granted ethical approval. Please
attach a copy of the ethical approval of the other organization.
Signature of Applicant_____________
Date_____________
Signature of the Supervisor_____________
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