Health Care Awards Nomination Form

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Part A: Nominee Information

Part B: Nomination Category

N.B. The North Shore Health Care Awards Committee reserves the right to change a Nominee's category.

Part C: Contact Information of Nominators

Three Nominators (staff and/or physicians) are required to support this nomination. Family members are exempt from nominating a candidate. Note that nominators may be contacted by a committee member as part of the evaluation process.




Part D: Why does this person deserve an Outstanding Achievement Award?