SSVMS Honors Medicine Award Nomination Form
Please use this form to nominate a physician or medical student for one of SSVMS's annual awards. For questions, contact Chris Stincelli at cstincelli@ssvms.org.
Your name
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First Name
Last Name
Your phone number
Please enter a valid phone number.
Your email
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example@example.com
Name of physician or medical student you are nominating
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First Name
Last Name
Medical group or affiliation
Golden Stethoscope Award
Criteria: Candidates for the Golden Stethoscope Award shall be judged primarily for their devotion to patient care and the medical needs of the community in an environment of unselfishness, compassion and empathy. The candidates shall be members in good standing of SSVMS and may be active, retired, or hold an administrative position.
Community Impact Award
Criteria: This commendation shall be given to a member of the Sierra Sacramento Valley Medical Society whose high achievement has allowed a contribution of great significance to community health. The candidates shall be members in good standing of SSVMS and may be active, retired, or hold an administrative position.
Excellence in Advocacy
Candidates for the Excellence in Advocacy Award shall be judged primarily for notable leadership and/or advancement of healthcare policy that directly benefits physicians and patients. The candidates shall be members in good standing of SSVMS and may be active, retired, or a medical student.
Outstanding Medical Society Volunteer
Advancing the mission and vision of SSVMS through notable contributions to the Society, patients, or charitable programs such as SPIRIT, Joy of Medicine, Future of Medicine, the Museum of Medical History, and more. The candidates shall be members in good standing of SSVMS and may be active, retired, or a medical student.
I would like to nominate this physician/medical student for:
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Golden Stethoscope
Community Impact
Excellence in Advocacy
Outstanding Medical Society Volunteer
I would like the Medical Society to select the award that best represents their contribution to medicine
Please tell us why you are nominating this physician/medical student
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Other comments
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