Physician Excellence Award Nomination Form

Thank you for taking a few moments to recognize a Physician colleague who displays outstanding excellence in performance of their duties involving patient care, leadership, education, academic achievement, program development, and/or any of the wide range of responsibilities associated with physician work in medicine. This is a peer-selected award; award recipients are motivated and dedicated to serving as inspirational role models to their colleagues.  Finally, recipients of the Physician Excellence Award stand out amongst their peers in their commitment to our mission as a “compassionate and transforming healing presence within our communities” and their values emulate those of Trinity Health: justice, safety, reverence, stewardship, integrity, and commitment to those who are poor.  Please provide specific “stories” and examples on “how and why” they have inspired you as a colleague.
1.Today’s Date:(Required.)
2.Your Name:(Required.)
3.First and Last Name of Physician Being Nominated: (including Department/Division)(Required.)
4.How did this Physician demonstrate excellence? Please provide specific examples or a story.  Submissions are used when a physician wins the award in announcements to demonstrate to all colleagues the contributions this physician has made to the community or organization. (Required.)