R T C C L E A R A N C E FOR PBR PART I

Year ____

NAME : ______________________________________________________________________________
MOBILE NUMBER:__________________________ EMAIL ADDRESS___________________________
HOSPITAL: ___________________________________________________________________________
DATE RESIDENCY TRAINING STARTED: __________________________________________________
DATE OF COMPLETION OF RESIDENCY TRAINING: _________________________________________
PRESENT YEAR LEVEL: ________________________________________________________________
RE-TAKER ( ) YES, How many times ___________ ( ) NO

PBR EXAMINATION I
Requirements:
_______ Attendance to scientific meetings
_______ Updated RTC Logbook
_______ In-Service Exams
_______ Research Paper (hard copy) signed by the Department Training Officer & Approved by the
Research Committee of PCR
_______ Endorsement Letter from Residents’ Department Training Officer
_______ Photocopy of the certificate of hospital accreditation when residency was started
_______ Photocopy of the present certificate of hospital accreditation
_______ Photopcopy of departmental logbook showing attendance to departmental and interdepartmental
conferences

To Philippine Board of Radiology:

I am respectfully endorsing the above-mentioned resident to take the PBR Part I written exam on
___________________. He/She has complied with all the RTC requirements.

_________________, MD
RTC Chair
Date:

= = = = = = = == = = = = = = = = = = = = = = = == = = = == = = = = = == = == = = = = = == == = = == = == =

RTC C L E A R A N C E FOR PART II & III

Year _____

NAME : ______________________________________________________________________________
MOBILE NUMBER:__________________________ EMAIL ADDRESS___________________________
HOSPITAL: ___________________________________________________________________________
DATE RESIDENCY TRAINING STARTED: __________________________________________________
DATE OF COMPLETION OF RESIDENCY TRAINING: _________________________________________
PRESENT YEAR LEVEL: ________________________________________________________________
RE-TAKER ( ) YES, How many times ___________ ( ) NO

PBR EXAMINATION II
Requirements:
___1) Certificate of endorsement from the training officer stating
a. The applicant’s current year level and expected date of completion of residency
b. That the applicant has taken and passed the PBRE part I
c. That the applicant has submitted the necessary papers, reports for promotion to the
next year level and cleared of any deficiencies
d. That the applicant is of good moral character
_____2) Photocopy of the certificate of hospital accreditation
a. Photocopy of the certificate of hospital accreditation when residency was started
b. Photocopy of the present certificate of hospital accreditation
_____3) Photocopy of hospital conferences
_____4) Attendance to scientific meetings
_____5) Updated RTC logbook
_____6) Copy of completed research paper signed by training officer & Approved by the
Research Committee of PCR
_____7) In-Service Exams
_____8) Photopcopy of departmental logbook showing attendance to departmental and interdepartmental
conferences

PBR EXAMINATION III

NO NEED FOR RTC CLEARANCE

To: Philippine Board of Radiology:

I am respectfully endorsing the above mentioned resident to take the PBR Part II
written exam on _____________. He/She has complied with all the RTC requirements.

________________, MD
RTC Chair
Date:
 SCIENTIFIC PAPER / PROPOSAL SUBMITTED FOR THE PBR I EXAM
(FORM RC 001)

To: The Applicant

Please make sure you keep a photocopy of this paper. You will need a clearance
from the Research Committee for your RTC clearance.

Checklist:
_____ 1. this application form
_____ 2. copy of the scientific paper (250 words for proposal)
_____ 3. copy of the paper in a compact disc (use windows please)
_____ 4. the above (1-3) should be submitted in duplicate and put in long brown
envelope addressed to the Research Committee of the PCR

Name of Applicant: _____________________________________________________

Present Year Level: _____________________________________________________
Number of Times PBR I was taken: _________________________________________
Mobile Number: _____________________________________________________
Email Address: _____________________________________________________
Hospital: _____________________________________________________
Training Officer (Name & Signature as proof he checked the applicant’s paper and
approved it: _____________________________________________________

Scientific Paper Submitted (Please check)

__________ Proposal
__________ Finished Paper

TITLE OF SCIENTIFIC PAPER

_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
___

PCR RESEARCH COMMITTEE

__________ Accepted
__________ Accepted with correction / revision (applicant should submit revision /
corrected paper before clearance is given)
__________ Not accepted (should submit a new one for approval)

To RTC Chaiman:
We have reviewed and approved the applicant’s scientific paper.

__________________________
(Research Committee Chairman)
SCIENTIFIC PAPER / PROPOSAL SUBMITTED FOR THE PBR II /III EXAM
(FORM RC 002)

To: The Applicant

Please make sure you keep a photocopy of this paper. You will need a clearance
from the Research Committee for your RTC clearance.

Checklist:
_____ 1. the application form (FORM RC 001) with notation from Research Committee
when proposal was submitted or letter from Research Committee about your
research proposal that was submitted before
_____ 2. this application form
_____ 3. copy of the completed scientific paper
_____ 4. copy of the paper in a compact disc (use windows please)
_____ 5. the above (1-4) should be submitted in duplicate and put in long brown
envelope addressed to the Research Committee of the PCR

Name of Applicant: _____________________________________________________

Present Year Level: _____________________________________________________
Number of Times PBR II was taken: _________________________________________
Mobile Number: _____________________________________________________
Email Address: _____________________________________________________
Hospital: _____________________________________________________
Training Officer (Name & Signature as proof he checked the applicant’s paper and
approved it: _____________________________________________________

Scientific Paper Submitted (Please check)

__________ Proposal
__________ Finished Paper

TITLE OF SCIENTIFIC PAPER

_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
___

PCR RESEARCH COMMITTEE

__________ Accepted
__________ Accepted with correction / revision (applicant should submit revision /
corrected paper before clearance is given)
__________ Not accepted (should submit a new one for approval)

To RTC Chaiman:
We have reviewed and approved the applicant’s scientific paper.

__________________________
(Research Committee Chairman)