北京积水潭医院伦理证明模板

Beijing Jishuitan Hospital

Institutional Review Board Approval Form (IRB)

This approval form must be included in all research papers and must be signed by the thesis investigator.

Project Information: Principal Investigator: Department: Department of , Beijing Jishuitan Hospital Project Title: Description of Proposed Project:

PI Certification:

I certify that the information provided above is accurate. I certify that I have received the appropriate training in the proper treatment of human participants in research. And I certify that all procedures described in this application are complete and accurate. All activities associated with this research project will be performed in accordance with Jishuitan Hospital Institutional Guidelines and Clinical Regulations. I agree to immediately report all unanticipated adverse affects of the study on subjects to the Chairperson of the Beijing Jishuitan Hospital Institutional Review Board.

Signature of Principal Investigator: Date:

Chairperson, Beijing Jishuitan Hospital Institutional Review Board(print): Youqing Xin

Signature: Date:

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