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KOMITE MEDIK F/006/015/R/00

RSUP FATMAWATI

HASIL PENILAIAN PROPOSAL PENELITIAN


RSUP FATMAWATI

Nama Peneliti : ...........................................................................


Pembimbing
: 1. ......................................................................
2. ......................................................................
3 ......................................................................

Judul Penelitian : ..........................................................................

Jenis Penelitian : ..........................................................................

Tempat Penelitian : ..........................................................................

Waktu Penelitian : ...........................................................................

PROPOSAL Ada Tidak


1. Latar Belakang/ Introduksi
2. Metodologi penelitian :
a. Desain Penelitian
b. Besar Sampel
c. Analisis Statistik
3. Daftar Referensi

4. Biaya Penelitian

5. Jadwal Penelitian

6. Surat Peryataan Kesedian berpartisipasi ikut


penelitian

7. Surat Persetujuan Etika Penelitian

8. Lain-lain :

Rekomendasi :

Jakarta, .......................

SMF ………………….., Presentan,


RSUP Fatmawati

_______________________ ____________________

Ka Bag. Diklit Ketua Sub Komite Diklit


RSUP Fatmawati Komite Medik RSUP Fatmawati

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KOMITE MEDIK F/006/015/R/00
RSUP FATMAWATI

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