DAISY Award Nomination Form
Thank you for taking time to nominate your GAH caregiver!
Nominate your Nurse for the DAISY Award or your CNA for the GAH VIOLET Award below!
Your Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Your Caregiver's Name
*
Your Caregiver's Job Title
*
Please Select
Registered Nurse
Licensed Practical Nurse
Certified Nursing Assistant
Unsure
Select Unsure if you don't know your nurse's title
Does your caregiver work in the Hospital or a Clinic?
*
Hospital
Clinic
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Nominate your Hospital Caregiver
Which unit does your caregiver work in?
Surgical
Medical
Obstetrics
Emergency Dept
Observation
Pre-Operative Services
Unsure
Please share your story of why your caregiver is so special, providing as much detail as possible.
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Nominate your Clinic Caregiver
Which GAH Clinic does your caregiver work at?
Family Healthcare of Fairbury
Family Healthcare of Farmer City
Gibson Area Medical Clinic
Gibson Area Primary Care
Gibson City Clinic
Gibson City Weekend Clinic
Gibson Health of Bloomington
Gibson Health of Cissna Park
Gibson Health of Hoopeston
Gibson Health of Mahomet
Gibson Health of Onarga
Gibson Health of Urbana
Gibson Health of Watseka
Gibson Obstetrics and Gynecology
GAH Annex
Outpatient Clinic
Prairie Family Medicine
The Paxton Clinic
Unsure
Please share your story of why your caregiver is so special, providing as much detail as possible.
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Submit
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