UT Health Science Center Handbooks and Procedures by Subject

View all UTHSC Handbooks and Procedures (numerical order) and descriptions

Academic, Faculty and Student Affairs

Academic Affairs

AA100-H – Attendance Policy

AA101-H – Credit Hour Policy

AA102-H – Distance Education and Off-campus Instructional Sites Policy

AA103-H – Certificate Policy

AA104-H – Continuing Education Policy

AA105-H – Course Numbering Policy

AA106-H – Credit for Prior Learning Policy

AA107-H – Curricular Changes Relating to Academic Programs

  AA108-H – Student English Language Proficiency

AA109-H – General Education Requirements Policy

AA110-H – Grading Policy

AA112-H – Foreign Nationals Policy

AA113-H – Program Review Requirements

AA114-H – Scheduling of Academic Pace and Ad Hoc Activities Procedure

AA115-H – Credit by Examination Policy

AA116-H – UTHSC Substantive Change Policy

AA117-H – Repeat Course Policy

AA118-H – Transfer Credit Policy

AA119-H – Recording of Faculty Lectures

AA120-H – Recognition of Accreditors


EM102 – Criminal Background Checks for Matriculating Students

EM105 – Reinstatement Policy

EM106 – Visiting Student Procedure

EM113 – Eligibility Verification Policy

Faculty Affairs

FA100 Adjunct Faculty Appointments at Other Institutions Policy

FA101 UTHSC Distinguished Professor Policy

FA103 Documentation and Recognition of Faculty Credentials

FA105 Volunteer Faculty Policy and Procedures

FA106 Certification of Effective Communication in English for Faculty

FA107 Faculty Educational and Development Leave Policy

Financial Aid

EM118 – Satisfactory Academic Progress

EM121 – Return of Title IV Funds

EM122 – Exit Counseling

EM123 – Federal Work Study Policy

EM124 – Financial Aid Verification Policy

Institutional Effectiveness

IE100 – Student Learning Assessment

International Affairs

IA100 – International Travel Requirements


EM100 – Annual Comprehensive FERPA Notice for Students

EM101 – Course Add Drop Policy

EM103 – Academic Calendar Policy

EM104 – Withdrawal Policy

EM107 – Attendance in Courses Pending VA Payment Policy

EM108 – Awarding of Degrees

EM109 – Effective Date of Student-Related Policies

EM111 – Student Death Procedures

EM112 – Student Status During Academic Appeals

EM118 – Satisfactory Academic Progress

EM119 – Catalog Year and Continuous Enrollment

EM120 – Academic Standing


SIM100 – Sim Confidentiality Policy

SIM101 – Sim Scheduling Policy

SIM102 – Sim Curriculum Development Policy

SIM103 – Sim Attire Policy

SIM104 – Sim Media Capture Policy

SIM105 – Sim Faculty/Facilitator Responsibilities

SIM106 – Remediation and Practice

SIM107 – Sim Physical and Psychological Safety

SIM108 – Sim Equipment, Supplies-Maintenance

SIM109 – Sim Equipment, Supplies-Separation

SIM110 – CHIPS Tour

SIM111 – SIM CHIPS Access

SIM112 – SIM Standard Patient (SP) Breaks

SIM113 – SIM Learner Evaluation of Activity

SIM114 – Sim Equipment – Storage

SIM115 – Sim Equipment, Supplies-Loan

SIM116 – Student Sim Requests

SIM117 – Professional Development

SIM119 – Makeup and Delayed Events

SIM121 – Faculty/ Facilitator Orientation

Student Affairs

EM117 – Guidelines for Treatment of Student Payments

SA105 – Preventing Student Mistreatment

SA107 – Accommodations for Religious Beliefs Practices and Observances

SA110 – Student Complaint Procedure

SA116 – Student Substance Use Policy


ADM0001-H – Commissioning of Police Officers – Campus Police

ADM0002-H – Protocol on Major Disturbances and Violent Crimes – Campus Police

ADM0003-H – Security Information Act – Campus Police

ADM0004-H – ID Card/Card Reader System and Key Control

ADM0100-H – Parking – Parking Services

ADM0200-H –  Facilities

ADM0201-H – Motor-Pool – Facilities

ADM0300-H – Leadership Institute – Administration

ADM0301-H – Appointment to Endowed Professorship or Chair of Excellence

Campus Safety and Emergency Management

Environmental Compliance

EC5400 – Hazardous Waste Disposal

Fire Safety

FS5300 – Fire Prevention Plan

FS5301 – Building Fire Watch Policy

FS5302 – Portable Fire Extinguisher Policy

FS5303 – Hot Work Policy

General Safety

GS5101 – Forklift Safety Policy

GS5102 – Ladder Safety Policy

GS5103 – Lock Out Tag Out Safety Policy

GS5104 – Motor Vehicle Safety Policy

GS5105 – Respiratory Safety Protection Policy

GS5107 – Slips, Trips and Falls Safety Policy

GS5108 – Unmanned Aircraft Systems Policy

GS5110 – Smoke Free Campus

GS5113 – Electrical Safety Procedure

GS5114 –  Safety Training Procedure

GS5115 – Emergency Eyewash and Safety Showers

GS5116 – Confined Space Written Program

GS5117 – Fall Protection

GS5200 – Exposure Control Plan 2022

RS001 – Chemical Hygiene Plan

Hazardous Materials Management

HM5100 – Hazard Communication Program

HM5200 – Compressed Gas Policy

HM5201 – Regulated Medical Waste Policy

HM5202 –  Controlled Substances Policy

HM5203 – Hazardous Waste Management

HM5204 – Waste Reduction Plan

College of Health Professions

COHP101 – Curriculum Committee – Academic Policy

COHP102 – Academic Faculty Mentoring Guidelines – Academic Policy

COHP103 – Credit Hour – Academic Policy

COHP104 – Distance Education and Off-Campus Instructional Sites Policy – Academic Policy

COHP105 – Grading Policy – Academic Policy

COHP106 – Waiver and/or Substitution Request – Academic Policy

COHP107 – Supervision of Student on Clinical or Fieldwork Assignment – Academic Policy

COHP108 – Student Scholarship Award Guidelines – Academic Policy

COHP109 – Honors Designation at Graduation – Academic Policy

COHP110 – Admissions Policy – Academic Policy

COHP111 – Withdrawal Policy – Academic Policy

COHP112 – Progress, Promotion and Academic Appeal Policy – Academic Policy

COHP113 – Immunization Policy – Academic Policy

COHP114 – Faculty Workload Policy – Academic Policy

COHP115 – Adjunct Teaching Recruitment and Evaluations Policy – Academic Policy

COHP116 – COHP Emergency Suspension of Operations on Campus – Academic Policy

COHP COVID-19 Contingency Plan

Annual Assessment Report Template

College of Medicine

COM-GS01 – Student Workload in the Pre-Clinical Curriculum – COM Medical Education

COM-GS02 – Student Complaint Logs (Guideline) – COM Medical Education

COM-GS03 – Student Video Platform Etiquette (Guideline) – COM Medical Education

COM101 – Continuous Quality Improvement – COM Medical Education

COM102 – Credit Hour Determination – COM Medical Education

COM103 –  Student Immunizations – COM Medical Education

COM104 – Visiting Students – COM Medical Education

COM105 – Progress, Promotion and Graduation with a Doctorate of Medicine (M.D.) – COM Medical Education

COM106 – Excused Absence and Wellness Days – COM Medical Education

COM107 – Grading for the MD Curriculum – COM Medical Education

COM108 –  Student Mistreatment – COM Medical Education

COM109 – Orientation of Resident and Non-Faculty Instructors in the Pre-Clerkship Phase – COM Medical Education

COM110 – Provision of Narrative Feedback to Medical Students – COM Medical Education

COM111 – Media Capture of Live-Lecture Sessions in the Pre-Clerkship Phase – COM Medical Education

COM112 – Work Hours – COM Medical Education

COM113 – Reinstatement to the COM – COM Medical Education

COM114 – Clinical Supervision of Medical Students – COM Medical Education

COM115 – Student Feedback and Course Evaluation Completion – COM Medical Education

COM116 – Inclement Weather – COM Medical Education

COM117 – Infection Control and Prevention of Exposure to Environmental Hazards – COM Medical Education

COM118 – Reporting Infections and Other Hazard Exposures – COM Medical Education

COM119 – Anti-Discrimination – COM Medical Education

COM120 – Committee Composition and Procedures – COM Faculty Affairs

COM121 – Professionalism – COM Medical Education

COM122 – Confidentiality and Conflict of Interest – COM Admissions

COM123 – COA Subcommittees and Procedures – COM Admissions

COM124 – Appearance Code for Simulated and Clinical Experiences – COM Medical Education

COM125 – Procedures to Ensure Timely Submission of Summative Assessments – COM Medical Education

COM126 – Faculty Participation in Outside Residences – COM Faculty Affairs

COM127 – Re-attestation to Meet COM Technical Standards – COM Medical Education

COM128 – Consent for Exams Under Anesthesia – COM Medical Education

COM129 – Provision of Formative Assessment and Feedback to Medical Students in the Pre-Clinical Phase – COM Medical Education

COM130 –  Excused Absence and Wellness Day Policy for Preclinical Curriculum – COM Medical Education

Communications and Marketing

CM0001-H – Advertising

CM0002-H – Email Signatures and Photos

CM0003-H – Interior Building Graphics

CM0004-H – Logo Usage

CM0005-H – Media

CM0006-H – Social Media

CM0007-H – Stationery, Publications, and Printing

Equity and Diversity

ED100 – Diversity Statement Policy

ED200 – Discrimination Complaint Procedure

ED300 – Search Procedures: Guidelines for Conducting Academic and Staff-Exempt Searches

ED400 – Sexual Harassment, Sexual Assault, Dating Violence, Domestic Violence, and Stalking


C0128-H – Campus Wide Training Approval

FI0120-H – Records Management

FI0125-H – Conflict of Interests

FI0126-H – Conflict of Interests (Interactions Between Health Care Professionals and Industry)

FI0130-H – Fraud, Waste, and Abuse

FI0135-H – Insurance

FI0140-H – Unclaimed Property

FI0145-H – Service and Recharge Centers

FI0150-H – Approvals

FI0200-H – Faculty Incentive Program – Sponsored Projects

FI0305-H – Accounts Receivable

FI0306-H – Procedure for Delivery of Credit Balance – Student Procedure

FI0307-H – Right to Cancel Notification Procedure – Student Procedure

FI0320-H – Indicia Licensing, Promotions, and Sponsorships

FI0325-H – Vending and Solicitations on Campus

FI0405-H – Procurement – Fiscal Procedure

FI0420-H – Service Contracts

FI0430-H – Receiving Materials

FI0435-H – Memberships and Subscriptions

FI0445-H – Employee Services Between UTHSC and State Institutions or Agencies

FI0450-H – Moving Expenses

  • FI0450B-H –

FI0475-H – Salary Advance

FI0505-H – Accounts Payable – Fiscal Procedure

FI0525-H – Petty Cash

  • FI0525E-H –

FI0605-H – Equipment

FI0610-H – Surplus Property

  • FI0610-S1-H – Surplus Property Transaction Form
  • FI0610-S3-H – Surplus Equipment Decontamination Form

FI0715-H – Entertainment – Fiscal Procedure

FI0720-H – Retirement Reception

FI0730-H – Wireless Equipment Allowance


HIPAA Privacy

H110 – Confidentiality of Protected Health Information

H115 – Safeguards for Protected Health Information

H120 – Patient Health Records

H125 – Notice of Privacy Practices

H126 – Notice of Privacy Practices (English)

H127 – Notice of Privacy Practices (Espanol)

H130 – Education and Training on Patient Privacy

H135 – Breach Notification

H140 – Business Associate Agreement

H141 – Business Associate Agreement Form

H200 – Use of Social Media – Patient Privacy

H210 – Patient Photography, Videotaping, and Imagery

Human Resources


HR0330-H – Educational Assistance (Fee Waiver)

HR0331-H – Educational Assistance (Spouse and Dependents)

HR0345-H – Group Insurance

HR0350-H – Holidays

HR0375-H – Retirement Plans

HR0390-H – Tax Deferred Income Program


COVID-19-H Telecommuting

HR0129-H – Performance Review

HR0135-H – Probationary Period

HR0145-H – Reduction in Force

HR0430-H – Job Classification

HR0432-H – Longevity Pay

HR0445-H – Overtime

HR0455-H – Pay Rates

HR0460-H – Spot Bonus

HR0465-H – CAP Exam

HR0472-H – Supplemental Pay

HR0480-H – Work Schedules

HR0485-H – Telecommute

HR0610-H – Limited Duration Appointment

Employee Relations

COVID-19-H Telecommuting

AD100-H Procedure for Compliance with Drug Free Campus

HR0128-H – Human Resource Development

HR0160-H – Termination

HR0220-H – Equal Employment Opportunity

HR0280-H – Sexual Harassment

HR0382-H – Sick Leave Bank

HR0525-H – Disciplinary Actions

HR0580-H – Code of Conduct

HR0630-H – Employee Relations Advisory Organizations

HR0640-H – Grievances

HR0720-H – Drug Free Campus Workplace

HR0820-H – Professional Attire


HR0110-H – Employment of Minors

HR0120-H – Retired Employees

HR0125-H – Employee Clearance and Exit Interviews

HR0130-H – Personnel Files and Release of Information

HR0143-H – Employment Procedure-Exempt and Non-Exempt Temp Pool

HR0150-H – Restoration in Force

HR0310-H – Continuous Service Credit

HR0320-H Administrative Closing and Inclement Weather


HR0305-H – Annual Leave

HR0315-H – Court Leave

HR0335-H – Educational Leave

HR0338-H – Family and Medical Leave

HR0339-H – Parental Leave

HR0340-H – Funeral and Bereavement Leave

HR0355-H – Leave of Absence

HR0360-H – Leave Transfer

HR0370-H – Military Leave

HR0373-H – Personal Leave

HR0380-H – Sick Leave

HR0395-H – Time Off To Vote

HR0397-H – Workers Compensation

General (ITS)

ITS-GP-001 – Standard on UTHSC Information Technology Standards and Practices


AC-001 – Access Control

AC-002 – Authentication

AT-001 – Training and Awareness

  • AT-001.02

AU-001 – Auditing & Logging Accountability

AU-002 – Logging and System Activity Review

CP-001 – Business Continuity Planning

CP-002 – Information Security during a Disaster

CS-001 – Device Life Cycle Security

CS-002 – Personally Owned Device Security

GP-001-UTHSC – Information Security Program

GP-001.04 – Information Security Violations

GP-002 – Data & System Classification

GP-003 – Expectation of Privacy

GP-004 – Acceptable Use of IT Resources


GP-006 – Email

GP-007 – Asset Management

GP-007.02 – Antivirus Antimalware Protection

IR-001- Security Incident Response

PE-001 – Physical Security of Information Resources and Related Facilities

PE-001.08 – Physical Security End-User IT Recourse

PS-001 – Personnel Security

RA-001 – Risk Assessment

RM-001 – Risk Management

RM-002 – Vulnerability Management

RM-003 – Patch Management

SC-001 – Network Security

SC-002 – System and Communication Protections

SC-003 – Application System Security

SC-004 – Wireless Network Security

SC-005 – Encryption

SC-006 – Internet Of Things Security


Export Control

EXPORT100 – UTHSC Export Control Policy


IACUC100 – Animal Transportation Policy

IACUC110 – Animal Treatment Concerns

IACUC120 – Executive Committee Role

IACUC130 – Mouse and Rat Toe Clipping Policy

IACUC140 – Murine Tail Biopsy Policy

IACUC150 – Rodent CO2 Euthanasia Policy


IBC100 – Additional Guidelines for the Transfer of Recombinant DNA Molecules into Human Subjects

IBC110 – Condensed Description of Biosafety Levels

IBC120 – General Guidelines – IBC Research

IBC130 – IBC Charter

IBC140 – Simplified Guidelines for Recombinant DNA Research


Continuing Review, Revisions, Closures, Records

CR001 – Continuing Review of Research

CR002 – Review of Revisions in Approved Studies

CR003 – Study Closure and Record Retention

Drug, Biologic, Device

DBD001 – Drug Biologic and Device – Emergency Use

DBD002 – Drug, Biologic Device – Significant Risk/Nonsignificant Risk Determinations for Medical Device Studies

DBD003 – Drug, Biologic Device – Humanitarian Use Devices (HUD)

DBD004 – Drugs, Biologics and Devices – Compassionate/ Treatment Use of Drugs, Biologics and Devices Under the FDA Expanded Access Program

Informed Consent

IC001 – Informed Consent and Confidentiality – Certificates of Confidentiality

IC002 – Informed Consent and Confidentiality – HIPAA Authorization

IC003 – Informed Consent and Confidentiality – Main Consent Form

IC004 – Informed Consent and Confidentiality – Informed Consent of Non-English Speaking Subjects, Illiterate English-Speaking Subjects, and Visually-Impaired or Hearing-Impaired English-Speaking Subjects

IC005 – Informed Consent and Confidentiality – Use of Protected Health Information Without Subject Authorization

IRB Review

IRBREV001 – IRB Review – Case Studies/Reports


IRBREV003 – IRB Review – Criteria for IRB Approval of New Research Applications

IRBREV004 – IRB Review – Expedited Review of New Studies

IRBREV005 – IRB Review – Authority, Membership, and Permanent Positions

IRBREV006 – IRB Review – NHSR Status for the Use of Selected Commercial Vendors and Specimen & Data Repositories

IRBREV007 – IRB Review – Determination of NHSR or Exempt Status

IRBREV008 – IRB Review – Procedures for Full Board Review

IRBREV009 – IRB Review – Use of Anonymized Human Cell Lines

IRBREV010 – IRB Review – Member Education

IRBREV011 – IRB Review – Utilization of Cooperative Agreements

Regulatory Compliance

REGCOMP001 – Regulatory Compliance – Responsibilities of Investigators

REGCOMP002 – Regulatory Compliance – Appeal of IRB Decisions

REGCOMP003 – Regulatory Compliance – Auditing of Research Studies

REGCOMP004 – Regulatory Compliance – Conflicts of Interest

REGCOMP005 – Regulatory Compliance – Responsibilities of Investigators

Safety Reports and Protocol Deviation

SRP001 – Review of Progress and Safety Reports, Other Than Reports of Unanticipated Problems

SRP002 – Safety Reports & Protocols – Reporting Unanticipated Problems Including Adverse Events

SRP003 – Safety Reports & Protocols – Protocol Waivers and Deviations

Vulnerable Populations In Research

VPOPUL001 – Vulnerable Populations in Research – Review of Research – Additional Protections for Children

VPOPUL002 – Vulnerable Populations in Research – Additional Protections for Prisoners

VPOPUL003 – Vulnerable Populations in Research – Additional Protections for Vulnerable Subjects – Pregnant Women and Fetuses


LACU100 – Access to Animal Facilities


LACU120 – USDA Categories

LACU130 – Use of Personal Protective Equipment (PPE) in Animal Facilities

LACU140 – UTHSC Mouse Cage Density Policy

LACU150 – UTHSC Rat Housing Policy

LACU160 – UTHSC Use of Drugs in Animal Experimentation

Research Policies

RES100 – Animals in Research

RES110 – Assurances of Compliance with Federal Regulations

RES120 – Compliance with Federal and State Regulations for Controlled Substances and Legend Drugs

Safety Affairs

RS002 – Exposure Control Plan








Radiation Saftey

L501 – Laser Safety Program

NRP01 – Non-Ionizing Radiation Program

RSP00 – Organization of the Radiation Safety Program

RSP01 – Enforcement of the Radiation Safety Program

RSP02 – Security of Radioactive Materials

RSP03 – Laboratory Survey Procedure

RSP05 – Use of Radioactive Materials in Animals

RSP07 – Safe Use of Radioactive Materials

RSP08 – Registration and Inspection of X-Ray Machines

RSP09 – Portable Radiation Survey Instrument Calibration and Use

RSP10 – Radioactive Waste Guidelines

RSP11 – Decay in Storage

RSP12 – Transport of Radioactive Materials on Campus Radiation Safety.docx

Space Policy

SPACE100 – Allocation of Research Space 2016

Sponsored Programs

FI0220-H – Cost Transfer Explanation Form

FI02050-H – Sponsored Projects

FI0250a-H – Request for Reallocation of Training and/or Research Grant Funds

FI0250b-H – Residual Supplies Inventory Form