LETTER OF REQUEST

April 3, 2024

Leticia H. Fuentebella, MD, MHSA

Medical Director
St. Mary's Medical Services, Inc.
J.P. Rizal St., Poblacion, Santa Maria, Bulacan

THRU: Jesusa J. Hermogenes, RN, MAN

Chief Nurse

SUBJECT: Requesting Authorization for Data Collection

Greetings!

We, a group of Grade 12 students under the Science, Technology, Engineering and
Mathematics (STEM) strand from Mater Dei Academy, are currently conducting a study entitled
“Bridging Beyond Screens: Charting Paths to Telemedicine for Advancing Healthcare
Community”. This letter intends to inform your office that we would like to conduct our
research with the patients and healthcare workers, such as nurses, techs, and if possible, residents
from St. Mary’s Medical Services Inc. as our respondents in our research paper in partial
fulfillment of the requirements in our course, Inquiries, Investigation, and Immersion.

With this, we humbly request your office for authorization to administer the survey
questionnaires to the healthcare workers and patients of St. Mary’s Medical Services Inc.. The
gathered data will be used solely for the purpose of obtaining valid and reliable data for our
research. The survey is planned to be conducted and distributed only during off-duty hours.

Rest assured that all data collected from the respondents will be kept confidential and will
solely be used for academic purposes. Anonymity and confidentiality will be strictly maintained
by the researchers, and the respondents names and the medical institution will not be disclosed to
any report or publications that will come off this study.

Granted that you authorize our request, kindly sign below acknowledging your consent to
conduct this survey.

We look forward to this letter of request reaching you with high spirits. Thank you and
God bless.

Respectfully yours,

Malvin S. Salvador II Kian Basti F. Berdonado

Lead Researcher Researcher

Stephanie May R. Mudlong Leonardo P. Castaneda

Researcher Researcher

Lian Adrielle G. Senora Guinevere G. Marquez

Researcher Researcher

Alanyz Carolyn C. Buluran Tabitha Joy V. Almodiel

Researcher Researcher

Chance Denmark T. Cruz

Researcher
Noted by:

Simon Zandro F. San Diego

Adviser, Inquiries, Investigation, and Immersion

Approved by:

Leticia H. Fuentebella, MD, MHSA

Medical Director, St. Mary’s Medical Services Inc.