LPG Physician Recognition Nomination Form
You have connected to the Lee Physician Group (LPG) physician recognition nomination site. The purpose of this site is to guide you through nominating an LPG physician for recognition. Finalists among the nominees will be honored at quarterly and annual LPG events. Physicians nominated will demonstrate characteristics such as professionalism, patient-centered care, servant leadership, compassion and empathy, innovation and creativity, exemplary quality and safety, team collaboration and spirit, community service, and a mentoring attitude and educational excellence along with other attributes consistent with our Exceptional Lee Promise. Nominations are continuous throughout the year and are open to all LPG physicians both clinical and non-clinical. Recognition categories will be assigned to nominees by the committee based upon your description and reasons for a physician’s nomination. Based upon your brief nominations on this form, award finalists will be selected and you may be contacted for additional information in the next few months. Your efforts to recognize and appreciate our LPG physicians will help to highlight exemplary physicians and to promote the exceptional culture of quality, caring, and compassion that we always aspire to have our patients associate with Lee Health!
Nominator
(Person submitting the nomination)
*
1.
Name:
(Required.)
2.
Contact Phone Number:
*
3.
Contact Email:
(Required.)
*
4.
Position
(Required.)
Staff/Nursing
Provider
Patient/Family
Non-Clinical
Other (please specify)
Physician Nominee
*
5.
Name:
(Required.)
6.
Specialty (if known):
*
7.
Facility
(Required.)
CCH
GCMC
GCHSWF
HPMC
LMH
Coconut Point
Ambulatory
Other (please specify)
*
8.
Reason for nomination (i.e. patient care, physician character, event/interactions) - up to 500 characters for description
(Required.)
