Covering Letter and Copyright Transfer Agreement
Corresponding Author
Name : Dr. Amelia Lorensia, S.Farm., M.Farm-Klin.,Apt.
Address/Affiliation : Fakultas Farmasi Universitas Surabaya. Jl. Raya Kalirungkut. .
Fax : (031)2981110
Tel : +62 81 55020707
Email 1 : [email protected]
Title of Manuscript : COST-EFFECTIVENESS ANALYSIS OF LENGTH OF HOSPITALIZATION OF USING INTRAVENOUS AMINOPHYLLINE AND NEBULIZED SALBUTAMOL IN ASTHMA EXACERBATIONS IN HOSPITAL IN SURABAYA
Author/s : Amelia Lorensia, Zullies Ikawati, Tri Murti Andayani, Daniel Maranatha
A. This is to confirm that:
a) The manuscript submitted has been prepared according to the journal’s ‘Instructions for Authors’, and checked for all possible inconsistencies and typographical errors.
b) On submission of the manuscript, the author/s agree not to withdraw the manuscript at any stage prior to publication.
c) Financial contributions to the work being reported are clearly acknowledged, as are any potential conflicts of interest.
B. The names and affiliations of two referees which the Indonesian Biomedical Journal (InaBJ) may decide to consult for the evaluation of the manuscript are listed below.
(Any suggested peer reviewers should not have published with any of the author/s of the manuscript within the past five years and should not be members of the same research institution.
Suggested reviewers will be considered alongside potential reviewers identified by their publication record or recommended by Editor in Chief or Associate Editor).
Referee 1
Name : -
Address/Affiliation : -
Email : -
Referee 2
Name : -
Address/Affiliation : -
Email : -
3. Copyright and License Agreement
For the submission of a 'manuscript' to InaBJ, I hereby certify that:
1. I have been granted authorization by my co-author/s to enter into these arrangements.
2. I hereby declare, on behalf of myself and my co-author/s, that:
a. The manuscript submitted is an original work and has neither been published in any other peer-reviewed journal nor is under consideration for publication by any other journal. More so, the work has been carried out in the author/s’ lab and the manuscript does not contravene any existing copyright or any other third party rights.
b. I am/we are the sole author/s of the manuscript and maintain the authority to enter into this agreement and the granting of rights to the publisher: the Prodia Education and Research Institute (PERI), does not infringe any clause of this agreement.
c. The manuscript contains no such material that may be unlawful, defamatory, or which would, if published, in any way whatsoever, violate the terms and conditions as laid down in the agreement.
d. I/we have taken due care that the scientific knowledge and all other statements contained in the manuscript conform to true facts and authentic formulae and will not, if followed precisely, be detrimental to the user.
e. I/we permit the adaptation, preparation of derivative works, oral presentation or distribution, along with the commercial application of the work.
f. No responsibility is assumed by InaBJ and PERI, its staff or members of the editorial boards for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products instruction, advertisements or ideas contained in a publication by InaBJ.
Copyright:
Author/s who publish in any InaBJ print & online journal will transfer copyright to their work to PERI.
Submission of a manuscript to the respective journals implies that all author/s have read and agreed to the content of the Covering Letter or the Terms and Conditions. It is a condition of publication that manuscripts submitted to this journal have not been published and will not be simultaneously submitted or published elsewhere. Plagiarism is strictly forbidden, and by submitting the manuscript for publication the author/s agree that the publishers have the legal right to take appropriate action against the author/s, if plagiarism or fabricated information is discovered. By submitting a manuscript, the author/s agree that the copyright of their manuscript is transferred to PERI, if and when the manuscript is accepted for publication. Once submitted to the journal, the author/s will not withdraw their manuscript at any stage prior to publication. However, the copyright will be released to author/s when the manuscript is rejected.
License Grant:
Copyright to the above work (including without limitation, the right to publish the work in whole, or in part, in any and all forms) is hereby transferred to PERI, to ensure widest dissemination and protection
SIGN HERE FOR COPYRIGHT TRANSFER: I hereby certify that I am authorized to sign this document either in my own right or as an agent of my employer, and have made no changes to the current valid document supplied by PERI.
Dr. Amelia
Lorensia, S.Farm., M.Farm.Klin.,Apt.Clinical Pharmacy Lecturer, Pharmacy Faculty of Surabaya University, Surabaya, Indonesia Print Authorized Name(s) and Title(s)
2 May 2018
__________________________________ ______________
Original Signature(s) (in ink or electronic) Date
For multiple author/s/co-author/s (if any, please add author list below accordingly):
Author:
Dr. Amelia Lorensia, S.Farm., M.Farm-Klin., Apt.
Department of Clinical pharmacy-Community, Faculty of Pharmacy, University of Surabaya, Jl. Raya Kalirungkut, 60293 Indonesia
Prof. Zullies Ikawati, Apt.
Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy Universitas Gadjah Mada, Sekip Utara Yogyakarta, 55281 Indonesia
DR. Tri Murti, Sp. FRSS., Apt.
Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy Universitas Gadjah Mada, Sekip Utara Yogyakarta, 55281 Indonesia
Dr. dr. Daniel Maranatha, Sp.P (K)
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Airlangga, General Hospital Dr. Soetomo, Surabaya
DR. Mariana Wahjudi,M.Si
Departement of Purification and Molecular Biology, Faculty of Biotechnology, University of Surabaya, Surabaya
*} This research is part of a dissertation by Amelia Lorensia guided by the three other authors.
Please scan your signed copy of this covering letter and submit it along with your manuscript by
‘online submission’ or ‘email to [email protected]’
or
Please sign copy of this covering letter and submit it along with your manuscript (all hardcopies) to:
Secretariat of The Indonesian Biomedical Journal (Attn: Mrs.Yusmiati) Prodia Tower 3F, Jl. Kramat Raya No. 150
Jakarta 10430, Indonesia
