The Deborah LaMarche Telehealth Excellence Award Nomination Form
Name of Nominator
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Organization
Name of Nominee
Nominee Organization
Nominee Email
Comments: please describe the nominee's work in IT to increase access to healthcare and improve healthcare outcomes through the application of technologies.
Submit
Should be Empty: