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* 1. Date:

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* 2. Name of the critical care team you are nominating:

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* 3. Institution of team you are nominating:

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* 4. Description of why you feel this team deserves recognition by the SCCM Ohio Chapter (can include details of recent initiatives, awards, or challenges the team has overcome, etc.):

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* 5. Your name and credentials:

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* 6. Your institution:

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* 7. Your email address:

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