General Hospital • Document Control

Policies & Procedures Tracker

F-OT-09

Originating Department

Policy Code / Number

Policy and Procedure Title

SN	Department / Unit	Received By (Name, Stamp & Signature)	Contact #	Date & Time	Status
1
2
3
4
5
6
7
8
9
10
11
12

* Mandatory Requirement

This completed form must accompany all new or revised policies submitted for review and approval across departments.

APP-LD-001 (1) Form 2 Page 1 of 1