Clinical Guideline: Submission

Title:

Primary Author:

CEC Delegate:

Are all associate authors listed in a separate table?

Is an evidence table attached?

Is an education and implementation plan attached?

Is an evaluation strategy developed and agreed?

Primary Author sign off:

Name

Signature

Date Guideline and associated documents submitted to CEC Secretary:

For committee use only

Date tabled at CEC:

Feedback / Outcome to Primary Author

CEC chair sign off	Date

EDON sign off	Date

Clinical Guideline and Procedure

RCH

2012-01-04