2. Research Title：

3. Research Leader

Name:

Institution: 

Tel:      

Email：

4. Research Program Overview

5. Potential Ethical Issues and Measures to Address Them

6. Research Leader Assurance

I declare that the contents filled out are true and I will conduct the research in strict accordance with the relevant contents of the approval form. I also declare that I will strictly abide by the national laws and relevant regulations, while protecting the health, rights and privacy of the research subjects.

Signature：                       

Date：

The following content is filled in by the Ethics Committee

7. Review Expert Opinion

After review, the research value of the project is high, the research design is reasonable, the consideration of potential ethical issues is adequate, the treatment measures taken are effective and appropriate, and it meets the ethical requirements and is approved to carry out the research.

Signature：                       

Date：

8. Ethics Committee Opinion

This committee has examined the scientific value and ethical issues of the research content and agreed to the implementation of the research.

Committee Chairman (signature)：                       

Ethics Committee (official seal)：