Sample Policy Template

By Greg Radinsky,^[1] JD, MBA, CHC, CCEP

Corporate Compliance


POLICY TITLE: [ADD TITLE]	ADMINISTRATIVE POLICY AND PROCEDURE MANUAL
POLICY #: [NUMBER]	CATEGORY: Compliance and Ethics
System Approval Date: [LEAVE BLANK] Site Implementation Date: [DATE]	Effective Date: [COPY FROM PREVIOUS VERSION (if applicable)] Last Reviewed/Approved: [LAST APPROVAL DATE]
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


APPROVAL:
Policy Committee
Clinical Operations Committee

Standardized Versioning History:

*=Policy Committee Approval; ** =Clinical Operations Committee Approval