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S AINT L OUIS U NIVERSITY A. BONIFACIO STREET, 2600 BAGUIO CITY, PHILIPPINES

S C H O O L O F N T U R L S C I E N C E S

Depar tment o f Medica l Labora tory Sc ience

9 December 2013

SIR/MADAM:

We, the undersigned third year Bachelor in Medical Laboratory Science students are presently conducting our research entitled: Diet and ABO Antibody Titer , in partialfulfilment to the requirements in Medical Technology Research. A prerequisite beforefloating the questionnaires is a content validity test.

In this regard, we would like to submit to your good office the attached instrument, i.e.the researchers-constructed survey questionnaire for your comments and suggestions,thus making the process of validating the said instrument.

We acknowledge your expertise in this particular endeavor.

Thank you for any favorable action regarding this request. Best regards and more power.

Very respectfully yours,

Valdez, Dennis Bryan A. Repoyo, Berlanne A. Paltep , Rashell Anne C.

Mendoza, Alliana Jean D. Pasion, Jared Kenan S.

Noted:

Ms. Ann P. Opiña, RMT, MHSMFaculty Research Promoter



S AINT L OUIS U NIVERSITY A. BONIFACIO STREET, 2600 BAGUIO CITY, PHILIPPINES

S C H O O L O F N T U R L S C I E N C E S

D e p a r t m e n t o f M e d i c a l L a b o r a t o r y S c i e n c e

INFORMED CONSENT

Research Title: Diet and ABO Antibody TiterResearchers: Valdez, Dennis Bryan A.

Pasion, Jared Kenan S.Repoyo, Berlanne A.Mendoza, Alliana Jean D.Paltep, Rashell Anne C.Opiña, Ann P.

Greetings!

You are being invited to participate in the study entitled Diet and ABO Antibody Titer underthe supervision of Ms. Ann P. Opiña,

The information provided on this form and the accompanying cover letter is presented to you inorder to fulfil the legal and ethical requirements for research studies at the Saint LouisUniversity, Baguio City.

Note that the following must have been explained well to you and you fully understand them before you sign this consent form.

1. The purpose of this study is to assess the effect of diet on the ABO antibody titer of therespondents. The knowledge gained from this study will guide the patients and also otherhealthcare professionals about the effect of diet on the ABO antibody titer.

2. Participation is voluntary. Refusal to participate or withdrawal from the study will present no penalty to participant.

3. The number of study participants is all BMLS third year students in Saint LouisUniversity.

4. The duration of the study will be two semester (June 2013- March 2014).

5. According to the researchers, reactions prior to blood extraction may include fear anduncontrolled behavior; during the collection, pain and bleeding may occur. If it happens,the researchers will not proceed immediately with the extraction or may stop theextraction process and give further instructions for you to follow.



6. In case of adverse reactions, there will be immediate treatment/hospitalization which will be available free charge. The researchers will provide reimbursement or payment for thetreatment and other expenses incurred because of the adverse event.

7. All your records or information will be kept strictly confidential.

8. You will be given information or results of the results of the tests that may be relevant toyour continued participation. You will also be informed of any new information whichmay be relevant to your continued participation.

9. You can call or ask questions anytime regarding this study. The contact person for furtherinformation or for consultation on diverse events is attached herewith.

10. Your signature on this consent form shows that you have been informed about theconditions and safeguards of this project.

I have read the information provided and I agree to participate in this study

_________________________________Signature of Participant, Date

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