BGHMC RESEARCH ETHICS COMMITTEE Form No.

: BGHMC-REC-
Form-01-005

Revision No.: 2
CHECKLIST FOR INITIAL REVIEW
Effective Date: 10-06-2017

Protocol Title:
_________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________

Primary Investigator/s:
_______________________________________________________________________________________________________________

CHECKLIST FOR INITIAL REVIEW

1. Letter of Application for Review addressed to the Chairperson:

CELESTRELL MAY W. ORAS-MACALINGAY, MD, FPOGS

Chairperson, Research Ethics Committee
Baguio General Hospital and Medical Center
Governor Pack Road, Baguio City

2. CV with 2 x 2 picture of PI and Co-Investigator/s

3. Document Receipt Form
4. REC Application For Protocol Review
5. REC Protocol Summary Sheet
Five (5) Hard Copies
Soft Copy (MsWord Format) to be sent to: bghmc.erc@gmail.com and must
be retrievable at the time of submission
6. Complete Research Protocol
Five (5) Hard Copies
Soft Copy (PDF Format) to be sent to: bghmc.erc@gmail.com and must be
retrievable at the time of submission
a. Study Budget
b. Technical Review Board Approval (If applicable)
c. Informed Consent Form (English, Ilocano, Tagalog If applicable)
d. Patient Information Form (If applicable)
e. Advertisement (If applicable)
CONTACT US
f. Investigatory Brochure (If applicable) BGHMC Research Ethics Committee
g. Case Report Form (CRF) (If applicable) Professional Education Training & Research
Office (PETRO)
h. Research Team List (If applicable) Baguio General Hospital and Medical Center
i. GCP Certificate (If applicable) Governor Pack Road, Baguio City 2600
Work Hours: Monday - Friday
7. Revised Protocol* 8:00 – 5:00 only
8. Revised Consent Form* Email: bghmc.erc@gmail.com
Website: www.bgh.doh.gov.ph go to
9. Protocol Resubmission Form* PETRO>RMS>ERC
10. Amendments* Landline: (074) 661-7910 loc 355

NOTE: Items with asterisk applies for re-submissions. Submit an MsWord format soft copy to be sent
to BGHMC REC email and Five (5) hard copies. You will be instructed if additional copies are
needed. Thank you.