A.I. Burnasyan Scientific journal FMBC

Clinical Bulletin

ISSN 2782-6430 (print)

State Research Center −Burnasyan Federal Medical Biophysical
Center of Federal Medical Biological Agency

The journal is published in Russian.
Format – A4.
The periodicity of the journal is 4 times a year.

Issue №3 2022 год

Author agreement form

Signing this agreement means that all authors have read the rules of the journal (Editorial Policy) and undertake to comply with them. The authors confirm that the submitted manuscript is an original article: it has not been published previously, including in part and / or in another language, and is not under consideration in another journal. The authors confirm that they do not publish information related to controlled technologies, or the publication of such information is agreed upon by a special expert council. The authors warrant that they followed the ethical requirements of the journal when conducting the study and preparing the manuscript.

The authors agree that they will be the copyright holders of the published text and graphics, but the scientific article will be distributed under the terms of the Creative Commons Attribution 4.0 International (CC BY) license. This means that anyone can use the published material for commercial or non-commercial purposes as long as credit is given to the authors.
To fill out the agreement on a computer, click on the appropriate boxes.

Article Title:


The authors:


Corresponding author:


Article type (review, original study, method, clinical case, opinion):


Author Contribution:

Briefly describe what part of the work each of the authors did: literature analysis, study design, data collection, data analysis, data interpretation, preparation of a draft manuscript, etc. If the contribution of all authors was equivalent, please note this after listing the essence of each work – torus. Please note that this data will be published in a journal.


Funding sources:

Please indicate the sources of third-party funding for the study and preparation of the manuscript: which organizations provided financial or other assistance in collecting, analyzing or interpreting data, in recruiting patients, or in solving other research tasks; whether the study or article was commissioned by a commercial entity. Corresponding author must confirm that he had access to all research data and is responsible for submitting the manuscript for consideration.

Attention: the information given here and on the title page of the manuscript must match.


Conflict of interest:

Each author who has conflicts of interest (see Section 5 “Ethical Requirements” of the Editorial Policy) must complete a declaration of conflicts of interest. In this case, check “See applications”. If there are no conflicts of interest, please indicate below: “None”.


Local ethics committee approval (specify committee name, protocol number and date):


Consent of patients and other persons mentioned in the manuscript:

Patients whose personal data is disclosed in the manuscript and the personalities mentioned in the Acknowledgments section must give written consent to this. Please indicate below if written permissions were obtained. You don’t need to send them with a copyright agreement.


I agree: with the submission of the article for consideration in the journal “Emergency Medicine”; the content of the article; including me as an author; declared conflicts of interest. I had full access to the study data and am responsible for their accuracy.


Full name                                                                                                                           SIGNATURE                                                         THE DATE




If there is not enough space for signatures, use the reverse side of the sheet.

Scroll to Top