| HIT Program Pro Forma Template |
| Scope of Technology Implemenation: |
| Software Licensing Terms: |
| | FY '01 | FY '02 | FY '03 | FY '04 | FY '05 | Totals |
| Capital Costs (one time costs that can be depreciated) |
| Consulting Services Vendor or Third Party |
| Implementation Salaries |
| Database Software |
| Hardware Costs—Servers & Devices |
| Network Costs—Additional Network Needed |
| Licensed Software—Vendor & Third Party Software |
| Capital Totals | $0 | $0 | $0 | $0 | $0 | $0 |
| Operating Costs (annual recurring costs) |
| Software Maintenance/Support |
| Hardware Maintenance/Support |
| Physician Salary Support |
| Support/Post Production Salaries (IT & Other) |
| Travel/Training |
| Other |
| Operating Totals | | $0 | $0 | $0 | $0 | $0 |
| Grand Totals (Capital & Operating) | $0 | $0 | $0 | $0 | $0 | $0 |
| FY - Fiscal Year |
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Week04_HITProgramProFormaTemplate.xls
