POLICY OR PROCEDURE REQUEST & APPROVAL
Type:
Policy


Procedure
Existing*
New
Document Title
Date
Policy or Procedure Owner (PPO)
Stakeholders


Number
(team involved in drafting)
Communication Points
(highlights of upcoming change)
Implementation Considerations
(include transition plan)
Education & Training Highlights
(include resources)
Desired Timing
(estimate completion date)
Regulatory References
(include links)
Reference Materials
(include links)
Supplemental Materials
(include links)
Forms
(include links and/or documents)
Approvals
POLICY
PROCEDURE
Signature
Signature
Approval Date
Approval Date
Signature
Signature
Committee Name/Review &
Recommend Date
Not Required
Vice President
Executive Team
CNM President
Governing Board - Other
Committee
Governing Board Executive
Committee
Review & Recommend Date
Full Governing Board
Resolution Number/Approval Date
*Include Redlined AND Final Drafts
Rev.091614