Document Receipt Form

(LDCUREB FORM 01)

LDCU-REB 2024-02-1128-CMLS
Document No.

Date 04/26/2024
submitted:

TITLE OF THE EVALUATING SYNERGISTIC EFFECTS: MALUNGGAY (Moringa oleifera)

STUDY SEED AND GUAVA (Psidium guajava) LEAF EXTRACTS ON E. COLI

Principal Balangao, Myrah Abigael S.  LDCU Faculty

Investigator:  Non-Liceo Researcher
 Other (please specify)
 _______________________

Telephone: Fax:

Email: mbalangao50959@liceo.edu.ph

Mobile number 09609008216 Preferred

□ Phone □ Fax
contact
□ E-mail □ Mobile

Department/Unit: College of Medical Laboratory Science

Document Number Effectivity Date Revision Number

LDCU-FORMS-REB-001 June 20, 2022 000
Type of  Initial Review  Informed Consent Form (ICF)
Submission amendment
 Resubmission for re review
 Version 2  Continuing Review Approved
protocols/Progress report
 Version 3  Early protocol termination
 Version 4  Request/Queries/Complaints report
 Other (Please specify)  Final Report
 Case Report registration
 Protocol Amendments  Meta-analysis registration
 01  Other (please specify) _____________
 02
 03

Principal investigator’s Date:

(Name and signature) 04/22/24
Myrah Abigael S. Balangao

Received by: Date:

(Name and signature)

Document Number Effectivity Date Revision Number

LDCU-FORMS-REB-001 June 20, 2022 000