SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM DEPARTMENT OF EDUCATION AND RESEARCH
RESEARCH INSTITUTIONAL APPROVAL
INSTRUCTION:
1. Please take note that if the research sites are MORE than three departments or units, you are required to fill up Section A and C only.
2. If the research site is LESS than three, you are required to obtain approval from each of Head of Department or Unit respectively.
A. REQUESTOR INFORMATION Name
Department & Institution Research Title
Signature & Stamp
Date
B. HEAD OF DEPARTMENT/ UNIT SASMEC @IIUM APPROVAL (Site of Research)
I agree to allow the above mentioned investigator to conduct or participate in the above titled research.
Name (Head of Department)
Department/ Unit Field Supervisor
* Please note that it is a requirement to have one SASMEC staff as a field supervisor from research site (research area/ venue)
Name : ………
Designation : ………
Signature & Stamp Please Tick (√) The Following Box:
Approved Not approved
Date: Comment: ________________________________________________________
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)-F004 VER: 01 REV: 04 EFFECTIVE DATE: 20 SEPTEMBER 2022IIUM-IIUMMC-F000
VER: 01 REV: 00
SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM DEPARTMENT OF EDUCATION AND RESEARCH
RESEARCH INSTITUTIONAL APPROVAL
C. DIRECTOR (CLINICAL), SASMEC @IIUM APPROVALI agree to allow the above mentioned investigator to conduct or participate in the above titled research.
Department /Unit Please Tick (√) where applicable
Orthopaedic Internal Medicine
Surgery Paediatric
Psychiatric Nursing
Emergency ENT
Radiology Pharmacy
Pathology Lab Medicine Medical Record
Opthalmology Obstetrics & Gynaecology
Dentist & Maxilofacial Rehabilitation Dietetic and Food Service ICU
Cardio Care Day Care
Haemodialysis Shariah Compliance
Operation Theatre Quality Assurance & Safety
Anesthesia Clinical Management
Education and Research HR & General Admin
Finance Facility & Engineering
Information Technology Medical Social Work Public Relations Legal & Governance
Compliance
Signature & Stamp Please Tick (√) The Following Box:
Approved Not approved
Date: Comment: ________________________________________________________
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)-F004 VER: 01 REV: 04 EFFECTIVE DATE: 20 SEPTEMBER 2022
