TRIMEDX John D Hughes Iconoclast Award

PRO TIPS:

Please fill out the following form carefully and completely, noting all of the required fields.
All email addresses must be in valid xx@xx.xx format.
16 MB limit on all file uploads.
Your nomination is only submitted once you have reached a screen with a green top bar saying “Thank you for taking this survey”.
Files and supplemental materials may be emailed to awards@aami.org.
Please direct any questions or support needs to awards@aami.org.

Nominee Information:

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* 1. Nominee's Name:

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* 2. Title:

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* 3. Company/Affiliation:

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* 4. Mailing Address:

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* 5. Phone Number:

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* 6. Email Address:

Nominator Information:

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* 7. Nominator's Name:

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* 8. Title:

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* 9. Company/Affiliation:

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* 10. Mailing Address:

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* 11. Phone Number:

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* 12. Email Address:

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* 13. Are you affiliated with the nominee? Note yes or no, and if so, describe your affiliation:

Award Criteria: Nominees must meet all of the following:

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* 14. Nominee demonstrates the ability for professionally challenge a commonly held perspective or position that results in moving an HTM program forward. Please describe:

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* 15. Nominee demonstrates a dedication to achievement in the HTM field. Please describe:

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* 16. Nominee has demonstrated significant contribution(s) to an important issue(s) facing their organization and/or the industry as a whole that push the general thinking or position currently in place. Please describe:

Award Criteria: Nominees should meet the following:

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* 17. Nominee has demonstrated leadership and a professional commitment to the field by writing articles for industry publications, participating in committees, and speaking at industry events. Please describe:

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* 18. Nominee has demonstrated evidence of HTM leadership and excellence in the workplace through, for example, contributions to management improvements, patient care, cost savings, or improvement in the use or impact of technology. Please describe:

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* 19. Nominator Cover Letter:

Upload nominators cover letter that provides a rationale statement describing the nominee’s significant contribution(s) to an important issue(s) facing their organization and/or the industry as a whole that push the general thinking or position currently in place.