CEBU CITY HEALTH DEAPRTMENT

Gen. Maxilom Avenue, Cebu City, Philippines

Division of Origin
HEALTH SYSTEMS SUPPORT DIVISION
Section Responsible
RESEARCH AND TRAINING PROGRAMS

Effectivity Date Nature of Document Document Code

November 11, 2022 Standardized Form RATP-RMT-01
Revision No Document Title
RATP-RMT-01 RESEARCH MONITORING TOOL
 

RESEARCH MONITORING TOOL

RESEARCH MONITORING TOOL

Part I.
Research Proponent: ________________________________________
___________________________________________
Research Title: ______________________________________________
__________________________________________________________
__________________________________________________________
Date: _________ Organization: ________________________________
Contact No.: _______________________________________________

Part II.
Data Needed: ______________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
Target Area: ________________________________________________
Target Population: __________________________________________
__________________________________________________________

To be filled up only by the Office of the CHD – HSSD

Part III. Checklist of Requirements:

 Letter of Intent
 Commitment Letter
 Data Consent Privacy Form
 MOA

Part IV. Initial Validation

 Data is Available
 Data is Not Available
 Recommended for Approval
Pls. specify reason: ___________________________________
___________________________________________________
___________________________________________________
___________________________________________________
 Not Recommended for Approval
 Pls. specify reason: ___________________________________
___________________________________________________
___________________________________________________
___________________________________________________

Comments/Suggestions:
__________________________________________________________
__________________________________________________________
__________________________________________________________

DATE: OCTOBER 24, 2022 CREATED BY: APPROVED BY: SIGNED BY:
MIA MARIE C. POLOGON, RPm DR. GRACE N. VALDEZ DR. DAISY S. VILLA, RN,MPA, DHCM