# Healthcare Program Intake Template

## Request
- Initiative name:
- Sponsor:
- Requesting team:
- Date submitted:

## Problem
- Problem statement:
- Target users:
- Current impact:

## Expected Outcome
- Desired outcome:
- Proposed measure:
- Target timeframe:

## Delivery Considerations
- Dependencies:
- Estimated effort:
- Required capabilities:
- Main risks:

## Decision
- Approve
- Clarify
- Sequence later
- Decline

## Decision Notes
- Decision owner:
- Decision date:
- Conditions: