How to Nominate an Extraordinary Allied Health Professional - SVBGH

Patients, visitors, nurses, physicians, employees may nominate a deserving Patient Care Technician (PCT) or ED tech by filling out this form and submitting it to the Charge Nurse.

I would like to nominate

In which unit does this person work?

Please describe a situation or story involving the Patient Care Technician or ED tech you are nominating that clearly demonstrates he/she meets the criteria for The Daffodil Award.

Thank you for taking the time to nominate an extraordinary, compassionate Patient Care Technician or ED tech for this award. Please tell us about yourself, so that we may include you in the celebration of this award should the nurse you nominated be chosen.

First name

Last name

Unit

I am

Nurse

Patient

Family/Visitor

MD

Staff

Volunteer

Home phone

Pager

Email

Date of nomination