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:

8.  Will the project involve human subjects? Yes / No

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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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