2022 AAHCM House Call Physician of the Year Award Nomination Submission

2022 AAHCM House Call Physician of the Year Award Nomination Submission
Award Eligibility & Process

Purpose: The AAHCM House Call Physician of the Year Award recognizes a home care physician who provides the highest quality of services and innovative programs and who demonstrates excellent and continued dedication to the field of home care medicine. (Must be an AAHCM member)

Nomination Deadline: August 31, 2022

Eligibility: Nominees must be AAHCM members in good standing. Self nominations are accepted. Current members of the AAHCM Board of Directors or AAHCM Awards Committee are not eligible to be nominated.

Nominations Process: All nominations packets must be submitted to Mel Douglas, AAHCM Executive Assistant at mel@aahcm.org by August 31, 2022 for consideration if not attached to this form. If emailed please make the nominee & award the subject. The nomination packet should consist of the following materials:
- Nominee's Curriculum Vitae (CV)
- Letter(s) of Recommendation : Nominator should submit 3 letters of recommendation from the nominee's peers, mentors, or colleagues. These letters should not exceed one page.
Supporting documentation such as formal commendations, citations or awards, newspaper or magazine articles, or other media-related profiles will be accepted, but shall serve only as evidence to support the nomination, and are NOT required.

An institution may not submit more than two award submissions per awards cycle. National institutions will be defined by state. Should the Awards Committee receive more than two award submissions from the same (state) institution, the burden of submission selection will fall on the submitting institution.

Award: The awardee will receive a one-year AAHCM membership and will be recognized at the AAHCM Annual Meeting with a personalized plaque.

Review Process: The AAHCM Awards Committee will review applications and select an award recipient. Nominators and nominees will be notified of a decision in September 2022.
2022 AAHCM House Call Physician of the Year Award Nomination Submission

Part 1
* 1. Nominator name and contact information.
Name
Institution
Address
Address 2
City
State
Zip Code
Email Address
example@example.com
Phone Number

Area Code Phone Number
2. Are you an AAHCM Member? *

Yes No
3. Enter the name(s) of additional nominators of this candidate (if applicable).
* 4. Nominee name and contact information.
Name
Institution
Institution Address
Address 2
City
State
Zip Code
Email Address
example@example.com
Phone Number

Area Code Phone Number
5. If this candidate is selected, may we notify their employer? *

Yes No
2022 AAHCM House Call Physician of the Year Award Nomination Submission

Part 2
*In the spaces below, please indicate how the individual you are nominating fulfills the following criteria for the AAHCM House Call Physician of the Year Award. For each item, describe in detail how the nominee has:
6. Demonstrated accomplishments of comprehensive and impactful care as a home care physician. *
7. Demonstrated accomplishments of involvement in community service. *
8. Demonstrated accomplishments or involvement on a local, state. or national level. *
9. Demonstrated involvement in activities that have advanced the image of home care medicine. *
2022 AAHCM House Call Physician of the Year Award Nomination Submission

Part 3
*In the space below, please provide any additional information you would like the committee to know.
10. Additional information about this nominee
2022 AAHCM House Call Physician of the Year Award Nomination Submission

Part 4
*In the space below, please provide a proposed citation of 25 words or fewer for the Award Plaque.

Example: An educational leader and role model who has shaped the career of many outstanding practitioners. A patient advocate first and foremost.
11. Proposed citation
2022 AAHCM House Call Physician of the Year Award Nomination Submission

Part 5
*Please attach a copy of the nominee's CV. (optional)

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2022 AAHCM House Call Physician of the Year Award Nomination Submission

Part 6
AAHCM House Call Physician of the Year Award Reference Letter Guidelines:

Demonstrated accomplishments of comprehensive and impactful care as a home care physician.
- Positively impacted patient resources, patient access and/or patient education.
- Encouraged collaboration that resulted in improved patient care.
Demonstrated accomplishments of involvement in community service.
- Created or promoted public awareness of the value of home care medicine.
- Served to improve the local community in addition to normal cinical duties.
Demonstrated accomplishments or involvement locally, in their state, or nationally for home care medicine.
- Demonstrated engagement, leadership, education/training, in the area of patient advocacy for home care medicine.
- Mentored home care clinicians, allied health professionals, and other learners.
Demonstrated involvement in activities that have furthered the image of home care medicine.
- Promote home care medicine among other specialty areas within the organization.
- Duration/type of service.
- Rural/remote or inner city settings.
- Patient advocacy.
*Please provide reference information below for reference #1.
Name
Institution
Address
Address 2
City
State
Zip Code
Email Address
example@example.com
Phone Number

Area Code Phone Number
13. Is Reference #1 an AAHCM Member? *

Yes No
*Letter of Reference #1 (optional)

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*Please provide reference information below for reference #2.
Name
Institution
Address
Address 2
City
State
Zip Code
Email Address
example@example.com
Phone Number

Area Code Phone Number
15. Is Reference #2 an AAHCM Member? *

Yes No
*Letter of Reference #2 (optional)

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*Please provide reference information below for reference #3.
Name
Institution
Address
Address 2
City
State
Zip Code
Email Address
example@example.com
Phone Number

Area Code Phone Number
17. Is Reference #3 an AAHCM Member? *

Yes No
*Letter of Reference #3 (optional)

Browse Files

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Thank you for your nomination. Click on the submit button to finalize your submission.

*If you have any difficulty uploading the Nominee's CV, or Letter(s) of Recommendation, please email them directly to: Mel Douglas at mel@aahcm.org.
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2022 AAHCM House Call Physician of the Year Award Nomination Submission

Award Eligibility & Process

2022 AAHCM House Call Physician of the Year Award Nomination Submission

2022 AAHCM House Call Physician of the Year Award Nomination Submission

2022 AAHCM House Call Physician of the Year Award Nomination Submission

2022 AAHCM House Call Physician of the Year Award Nomination Submission

2022 AAHCM House Call Physician of the Year Award Nomination Submission

2022 AAHCM House Call Physician of the Year Award Nomination Submission

AAHCM House Call Physician of the Year Award Reference Letter Guidelines:

Thank you for your nomination. Click on the submit button to finalize your submission.