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Republic of the Philippines

Department of Health
BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER
Baguio City
Doc. No.: TM-PETO-RD-008
Professional Education & Training Office
Rev. No. Ø
APPLICATION FOR RESEARCH EXTENSION Effectivity Date: October 1, 2016

Date
Name of Researcher
Contact Number/s
Department
Title of Research

Date Started
Reasons for Extension

Recommendation:

______ Approved

______Disapproved

if Approved, Length of Extension ____________________________________________________

____________________________________________________________________________________________

if Disapproved, Reason for Disapproval ___________________________________________

____________________________________________________________________________________________

SHEILA MARIE S. VILLANUEVA, MD, MPH, DIH


TRB Chairperson

Noted by:

CONCESA PADILLA, MD, FPPS, FPSN, FPNSP


Chief Training Officer, PETRO

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Republic of the Philippines
Department of Health
BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER
Baguio City
Doc. No.: TM-PETO-RD-008
Professional Education & Training Office
Rev. No. Ø
APPLICATION FOR RESEARCH EXTENSION Effectivity Date: October 1, 2016

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