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Daisy Award

Your Name:

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I am a (check one):

Patient

Family / Visitor

Staff

I would like to nominate

Nurse Name:

Unit / Department:

as a deserving recipient of the DAISY Award.

Our interaction took place at:

On:

Please describe a situation or story involving the nurse you are nominating that clearly demonstrates he/she meets the below criteria for the DAISY Award:

Demonstrates compassion and caring
Promotes patient- and family-centered care
Displays integrity, accountability and respect in the workplace

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