UTMB HANDBOOK OF OPERATING PROCEDURES

Section 1 Official Governance Subject 1.1 Official Governance Documents Policy 1.1.3 Institutional Handbook of Operating Procedures

05/01/88 -Originated 08/29/03 -Reviewed/ w changes -Reviewed w/o changes President's Office -Author

Institutional Handbook of Operating Procedures

Introduction

The Regents' Rules require the President of each UT System component institution to publish a Handbook of Operating Procedures that promulgates the official policies and procedures of the institution. Authority for establishing institutional policies and procedures is delegated by the Board of Regents to the President, subject to the approval of the Office of the Executive Vice Chancellor for Health Affairs. Should there be a conflict between the Handbook and the Regents' Rules, the Regents' Rules shall prevail, and the institutional Handbook shall be amended immediately to eliminate such conflict.

Audience

The information in this document is for use by all employees and students.

Policy

Before official publication in the Institutional Handbook of Operating Procedures manual, policies shall undergo review and approval at the following levels: 1) Institutional Handbook of Operating Procedures Committee 2) President's Council 3) Office of the Executive Vice Chancellor for Health Affairs Additionally, all Section 9 (i.e., Clinical) policies shall undergo review and approval by the Clinical Policies and Procedures Committee prior to review by the above-listed levels. In situations where it is mandated that information be distributed immediately, a draft policy may be distributed upon approval by the President's Council.

Review and Approval

The Institutional Handbook Committee, appointed by the President, is responsible for the maintenance of the UTMB Institutional Handbook. This responsibility includes: • Ongoing coordination of the amendment and approval pro- cess of all institutional policies to be included in the Handbook. • The distribution of all policies in accordance with an appropriate mailing list maintained by the President's Office.

Review and Approval (cont'd)

New policies or amendments to existing policies may be proposed by any individual, group or committee at UTMB by submitting the information or idea for the policy through the appropriate departments/committees to the UTMB Handbook Committee Chairperson or Coordinator. Individuals requiring assistance in identifying the appropriate channel for processing a proposed policy may contact the Handbook Chair or Coordinator for assistance.

Communication	Upon approval by UT System, all Handbook holders are responsible for updating their copies of the Handbook; all policy updates will be published on the Web; and, notification of the approvals will be sent via the UTMB E-mail Broadcast Daily Announcements. The Handbook is available on the Web at http://www.utmb.edu/policy.
Reference	Regents' Rules and Regulations, Part One, Chapter III, Sections 9