SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM DEPARTMENT OF EDUCATION AND RESEARCH
CHECKLIST OF DOCUMENT REQUIRED FOR RESEARCH APPLICATION
Sultan Ahmad Shah Medical Centre @IIUM, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur.
Tel: 09-591 2500
SASMEC-DEAR-CRC (GR)-F001 VER: 01 REV: 01 EFFECTIVE DATE: 20 SEPTEMBER 2022
DOCUMENT REQUIRED BEFORE RESEARCH START AVAILABILITY FOR OFFICE USE ONLY
NO ITEM YES NO RECEIVED DATE RECEIVED BY
1. Research Application Form*
2. Copy of Research Proposal
3. Summary Research Proposal Form*
4. Copy of Approval Letter from Kulliyyah Research Committee (KRC)/ or Recommendation Letter from Respective Institution (Non-IIUM)
5. Copy of Ethical Approval Letter from IIUM:
a) IIUM Research Ethics Committee (IREC)- If relate to human study (https://www.iium.edu.my/centre/irec/guid eline)
b) Institutional Animal Care and Use Committee (I-ACUC)- If relate to animal study (https://www.iium.edu.my/centre/iacuc/ho w-to-apply-3)
6. Copy of Student/Staff Card 7. Institutional Approval Form*
8. i-Pesakit Access Form* (If Required)
9. Re-education certificate (If applicant need to be physically present in SASMEC)
10. Appointment Letter for Field Supervisor
(Please note that it is a requirement to have one SASMEC staff as a field supervisor from research site (Departments/ Clinics/ Wards)
Remarks (if any) : Instructions:
a) Please refer to the checklist as a guideline on the forms and documents required for any research conducted at Sultan Ahmad Shah Medical Centre @ IIUM
b) Please submit the completed forms and all required documents to Clinical Research Centre, Sultan Ahmad Shah Medical Centre @ IIUM. Application will ONLY be processed if the forms and documents submitted are complete.
c) *Please obtain these forms from Clinical Research Centre or on SASMEC Official Website, https://sasmec.iium.edu.my/index.php/enru/enru-download
d) Please note that it is compulsory to apply for ethic approval from the IIUM Research Ethic Committee (IREC) including for those who have received ethic approval from other research/ethic board including MREC. Please submit the approval to IREC to expedite the process.
SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM DEPARTMENT OF EDUCATION AND RESEARCH
CHECKLIST OF DOCUMENT REQUIRED FOR RESEARCH APPLICATION
Sultan Ahmad Shah Medical Centre @IIUM, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur.
Tel: 09-591 2500
SASMEC-DEAR-CRC (GR)-F001 VER: 01 REV: 01 EFFECTIVE DATE: 20 SEPTEMBER 2022
DOCUMENT REQUIRED AFTER APPROVAL AND END
OF RESEARCH AVAILABILITY FOR OFFICE USE ONLY
NO ITEM YES NO RECEIVED DATE RECEIVED BY
1. Non-Disclosure Agreement (NDA)* (Submit this document ONLY AFTER obtain approval)
2. Progress Report Form* (Submit in the middle of the study duration)
3. Completion Report Form*
4. Research Output (Findings/ Abstract (from thesis)/ Research publication)
Remarks (If any)
:
CHECKED BY:
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VERIFIED BY:
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(Signature and Stamp)
Date : ………..
(Signature and Stamp)
Date : ………..
