I wish to nominate the following Healthcare provider/employee for The Rose Award
First and Last Name
Department
Department Name i.e. ICU, EC, 2S, 3S, 4N, Behavioral Health, Cath Lab, Surgical Services, Office, Infusion Clinic, etc.
I am a(n)
Patient
Visitor/Family Member
Employee
Physician
Other
Please check one:
I authorize my name to be used in ProMedica recognition materials for this nurse.
I do not authorize my name to be used in the ProMedica recognition materials for this nurse.
Your Name and telephone number
First and Last / Telephone number
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Describe your experience with this provider/employee and why this person is a deserving recipient of the Rose Award. Please provide details as to how the nominee demonstrated a commitment to excellence, clinical expertise, extraordinary service and/or compassionate care with a specific patient and/or family.
Submit
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