______

______

______

(Topic of thesis)

THESIS PROPOSAL

FOR APPROVAL OF SUBJECT OF THESIS TO BE SUBMITTED

IN PARTIAL FULFILMENT OF THE REQUIREMENTS

FOR THE DEGREE OF

Doctor of Medicine / Master of Surgery

in

______

(Name of the Department)

OF THE

BABAFARIDUNIVERSITY OF HEALTH SCIENCES

FARIDKOT

(Month, year) Name of the Candidate

Department of ______(in capital letters)

(speciality)

Name of MedicalCollege (in capital letters)

(One page abstract)

ABSTRACT OF PLAN OF THESIS

Title
For the degree of
Name of the candidate
Supervisor
Co-supervisor
Institution / Dayanand Medical College & Hospital, Ludhiana
University / Baba Farid University of Health Sciences, Faridkot

Introduction:

Aim of study:

Materials and methods:

Clinical significance:

Keywords:

(Signature)
Candidate / (Signature)
Co-supervisor / (Signature)
Supervisor / (Signature)
Principal

CERTIFICATE OF FACILITIES AVAILABLE

This is to certify that the facilities for work on the subject of thesis titled ______

Exist in the Department of (______), (______)

Speciality Name of the institution

and will be provided to the candidate. We will see that the data being included in the thesis are genuine and is collected by the candidate himself/herself under our supervision and guidance.

Name, designation & signatureName, designation & signature

Of Co-supervisorof Supervisor

(Head of the Department)

Countersigned

Place : ______

Date : ______

APPROVAL PROFORMA

BY

RESEARCH & ETHICAL COMMITTEE

DAYANANDMEDICALCOLLEGE & HOSPITAL, LUDHIANA

Name of candidate
Department
Topic of Thesis
Likely date of appearing in PG examination
Date of enrollment
Name of Head of Department
1)Supervisor
2)Co-Supervisor
Signature of Members of Research Committee with Stamp / Signature of Members of Ethics Committee with Stamp
1. HOD Pharmacology /
  1. HOD Physiology

2. HOD Surgery /
  1. HOD Pathology

3. HOD Pathology /
  1. HOD Pharmacology

4. HOD Medicine /
  1. HOD SPM

5. Dean Academics /
  1. HOD Medicine

6. Vice Principal /
  1. HOD Surgery

  1. HOD Obst. & Gynae.

8. Legal Expert
9. Secretary, IEC
10. Dean Academics
11. Vice Principal
  1. Principal

Approved : Yes / NoApproved : Yes / No

ChairpersonChairperson

Research CommitteeEthics Committee

BABAFARIDUNIVERSITY OF HEALTH SCIENCES, FARIDKOT

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS
2 / NAME OF THE INSTITUTE
3 / COURSE OF STUDY AND SUBJECT
4 / DATE OF ADMISSION OF COURSE
5 / TITLE OF THE TOPIC
6 /

BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY
(Limit to 1-2 pages)

6.2 REVIEW OF LITERATURE

(Limit to 2-3 pages)

6.3 AIMS AND OBJECTIVES OF THE STUDY

(Restrict to not more than 2)
7 /

MATERIALS AND METHODS

(Add details)

7.1 SOURCE OF DATA

7.2 METHOD OF COLLECTION OF DATA

8 /

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS ? IF SO, PLEASE DESCRIBE BRIEFLY.

7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3 ?
(Applied for)
LIST OF REFERENCES
(Upto 25 references)
(Vancouver style – ICJME guidelines)

CERTIFICATE OF DEPARTMENTAL CLEARANCE

This is to certify that the plan of thesis entitled ______has discussed in the Department of ______and approved by whole of the faculty of the department. The plan writing is satisfactory.

(Signature, name & designation (Signature, name & designation

of Supervisor) of Co-supervisor)

DAYANANDMEDICALCOLLEGE & HOSPITAL

LUDHIANA

Ref. No: DMCH/Dated :

TO WHOM IT MAY CONCERN

Certified that the study entitled ______

______

involves only such investigations and / or treatment, which are relevant in the management of patients and has no extra cost implications to the patient.

Name of candidate:______

Supervisor:______

Co-Supervisor(s):______

______

Signature of candidate

______

Signature of Supervisor

DAYANANDMEDICALCOLLEGE & HOSPITAL,

LUDHIANA

Ref. No. DMCH/Dated :

TO WHOM IT MAY CONCERN

I shall carry out the study “ ______

______”

meticulously and shall maintain the records for 5 years after the submission of

thesis and present them to any competent authority as and when required. The

following documents will be preserved :

  1. List of enrolled patients with identification details
  2. Consent forms of all the enrolled patients
  3. Proforma of each patient with verifiable details, individually signed by supervisor.

Dr.

P.G. Registrar

Dept. of

DMC & Hospital, Ludhiana

CERTIFICATE

We hereby certify that the informed patient consent form and its translation and back translation to Hindi and Punjabi are accurate to the best of our knowledge and satisfaction.

(Signature, name & designation (Signature, name & designation

of Supervisor) of Co-supervisor)

(Signature & name of candidate)