Corporate Compliance
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POLICY TITLE: [ADD TITLE] |
ADMINISTRATIVE POLICY AND PROCEDURE MANUAL |
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POLICY #: [NUMBER] |
CATEGORY: Compliance and Ethics |
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System Approval Date: [LEAVE BLANK] Site Implementation Date: [DATE] |
Effective Date: [COPY FROM PREVIOUS VERSION (if applicable)] Last Reviewed/Approved: [LAST APPROVAL DATE] |
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Prepared by: [NAME] Office of Corporate Compliance |
Notations: |
GENERAL STATEMENT of PURPOSE
POLICY
SCOPE
DEFINITIONS
PROCEDURE
REFERENCES to REGULATIONS and/or OTHER RELATED POLICIES
CLINICAL REFERENCES/PROFESSIONAL SOCIETY GUIDELINES
ATTACHMENTS
FORMS
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APPROVAL: | |
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Policy Committee | |
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Clinical Operations Committee | |
Standardized Versioning History:
*=Policy Committee Approval; ** =Clinical Operations Committee Approval
Instructions for Completing the Template
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The approved font is Times New Roman 12 pt.
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All fields within the template need to be completed. If there is no information for that section, input N/A.
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Once approved by Clinical Operations Committee, each facility will type its facility name by replacing text “(Facility Identifier)” under Health System logo.
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Policy Title: Name of Policy.
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Policy Number: All new policy numbers are assigned by System P&P Office; existing policy numbers are carried over with policy.
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System Approval Date: Date approved by System Operations Committee. Inserted by System P&P Office.
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Site Implementation Date: Inserted by System P&P Dept. This date is approximately 8 weeks post System Clinical Operations approval.
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Effective Date: Date policy first created and approved.
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Last Reviewed/Approved: Date last version of policy was reviewed and approved.
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Prepared By: Policy Owner/Committee/Department
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Notations: List the policy(s) merged into current version and/or policies to be archived and any other applicable notations including sites/departments where policy may not be applicable.
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GENERAL STATEMENT of PURPOSE: Overview/Intent of the policy.
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POLICY: The specific policy as stated in the regulations or defined by the policy owner.
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SCOPE: Defaults to Health System approved standardized language.
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DEFINITIONS: The definitions of any item specific to this policy.
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PROCEDURE/GUIDELINES: The main body of the policy. Should include an outline of specific steps/items to be followed or performed in implementing this specific policy.
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REFERENCES to REGULATIONS and/or OTHER RELATED POLICIES: A listing of the actual regulation, including regulatory agency and regulation number and or policy number where applicable. These are listed only as necessary. Do not link to any other policy directly. If you are referring to another policy you can have your link go to “Intranet Policy Page” The url is https://intranet.xxx.com
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CLINICAL REFERENCES: A listing of clinical documents that have either background information or have a direct connection to the policy. These are listed only as necessary.
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FORMS: List all forms/#’s referenced in the policy. Attached Vital Docs Link as applicable. There is a link to the Vital Docs Website at the top right corner of the Policies page underneath the horizontal navigation. The url is https://secure.xxx.com
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Approval: Approval dates of The Policy Committee and Clinical Operations Committee. Inserted by System P&P Office.
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Footer: The Footer will include the Policy #, the latest System approval date and page X of Y, with Y being the total number of pages.
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Standardized Versioning History: Input previous system approval dates.
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All previously approved/older versions must be stored in the Site’s Archive Link.
[FOOTER]
Page #X of #Y, [POLICY NUMBER], [DATE]
COPY FOOTER FROM PREVIOUS VERSION, CHANGE DATE TO [CURRENT DATE].