Proposal Submission Form LGHPES Project Proposal Background Information Order Number 1. Name of Potential Project and Amount of Funding Being Requested: 2. Issue 3. Area(s) of Impact (Identify all areas that resolution to this issue would affect.) Patient Care Physician Work Environment Population Health Reduction in Per Capita Cost Capacity & Flow Delivery of Program Services Patient Safety Use of Allied Health Professionals Electronic Systems Communication with Physicians Physicians Representation/Input Mechanisms Other (please specify 4. Background & Status 5. Options 6. What are the Risks/Challenges of Project and Expected Outcomes if this Project is Successful? 7. Is This Project a Collaboration between Physicians and the Health Authority (i.e. VCH) 8. Contact Information for Physician or Admin Lead and Physician(s) affiliated with Project: Once your proposal has been submitted, our Admin team will get back to you with follow up information and timelines on when you can expect to hear if your project or committee has been approved.