Promise in Action

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Image Field
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Hi! Let's begin with your name.* This field is required.
First Name
Last Name
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Hi {name}, are you recognizing an individual caregiver or a team of caregivers today?* This field is required.
Individual
Team
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Which ministry does this {hiname} belong too?* This field is required.In both hospitals, select the ministry where they action took place. There are no wrong answers.
5
What is the name of the Caregiver you are recognizing?Please ensure accurate spelling of the caregiver's name. Incorrect spelling could prevent the caregiver from receiving this nomination or from being counted towards their milestone pin count.
First Name
Last Name
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Great! Where is {whatIs}'s office or department located?
Please Select
Please Select
Administration
Caregiver Health
Case Management
Communications/Marketing
Emergency Department
Engineering / Facilities
EVS (Housekeeping)
FANS (Food and Nutrition Services/Dietary)
Health Information Management
HPG Clinic
Human Resources
Intensive Care Unit (ICU)
Imaging
Infection Prevention
IT
Lab
Materials Management
Med-Surg Unit
Medical Staff Services
Mission Integration
Nursing Administration
Nursing Education
Patient Access
Patient Experience
Pharmacy
Philanthropy
Quality & Clinical Excellence (QAPI), Risk, Pt. Safety, IP
Rehab Services (OT/PT)
Respiratory Therapy
Safety
Security
Specialty Clinic
Stroke
Sub-acute
Surgery (PACU, Peri-op, OR)
Wound Care
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Great! Where is {whatIs}'s office or department located?
Please Select
Please Select
Administration
Auxiliary
Caregiver Health
Communications/Marketing
Emergency Department
Engineering / Facilities
EVS (Housekeeping)
FANS (Food and Nutrition Services/Dietary)
Health Information Management
Human Resources
Intensive Care Unit (ICU)
Imaging
Infection Prevention
IT
Lab
Materials Management
Med-Surg Unit
Medical Staff Services
Mission Integration
Nursing Administration
Nursing Education
Patient Access
Patient Experience
Pharmacy
Philanthropy
Quality & Clinical Excellence (QAPI), Risk, Pt. Safety, IP
Rehab Services (OT/PT)
Respiratory Therapy
Safety
Security
Specialty Clinic
Stroke
8
Would you like to share the names of the caregivers for the team you are recognizing?
Yes
No
9
Who are the caregivers or providers you are recognizing as part of this team?Please ensure accurate spelling of the caregiver's name. Incorrect spelling could prevent the caregiver from receiving this nomination or from being counted towards their milestone pin count.
10
Who is the team you are recognizing today?
Please Select
Please Select
Administration
Caregiver Health
Communications/Marketing
Emergency Department
Engineering / Facilities
EVS (Housekeeping)
FANS (Food and Nutrition Services/Dietary)
Health Information Management
HPG Clinic
Human Resources
Intensive Care Unit (ICU)
Imaging
Infection Prevention
IT
Lab
Materials Management
Med-Surg Unit
Medical Staff Services
Mission Integration
Nursing Administration
Nursing Education
Patient Access
Patient Experience
Pharmacy
Philanthropy
Quality & Clinical Excellence (QAPI), Risk, Pt. Safety, IP
Rehab Services (OT/PT)
Respiratory Therapy
Safety
Security
Specialty Clinic
Stroke
Sub-acute
Surgery (PACU, Peri-op, OR)
Wound Care
11
Who is the team you are recognizing today?
Please Select
Please Select
Administration
Auxiliary
Caregiver Health
Communications/Marketing
Emergency Department
Engineering / Facilities
EVS (Housekeeping)
FANS (Food and Nutrition Services/Dietary)
Health Information Management
Human Resources
Intensive Care Unit (ICU)
Imaging
Infection Prevention
IT
Lab
Materials Management
Med-Surg Unit
Medical Staff Services
Mission Integration
Nursing Administration
Nursing Education
Patient Access
Patient Experience
Pharmacy
Philanthropy
Quality & Clinical Excellence (QAPI), Risk, Pt. Safety, IP
Rehab Services (OT/PT)
Respiratory Therapy
Safety
Security
Specialty Clinic
Stroke
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Using "know me," "care for me," or "ease my way," please select the area of our promise statement that best describes this recognition.* This field is required.
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Describe how this caregiver or team demonstrated Our Promise of "Know me, care for me, ease my way." Please share specific details to illustrate the impact these behaviors and actions made.* This field is required.Start with the SITUATION, provide the ACTIONS taken and share the RESULTS that occurred.
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