Providence Centralia Hospital DAISY Nomination

Page 1 of 1

The DAISY (Diseases Attacking the Immune System) Award is an international recognition program that honors and celebrates the skillful, compassionate care nurses provide every day. The DAISY Foundation was established by the family of J. Patrick Barnes after he died from complications of the auto-immune disease ITP in 1999. During his hospitalization, they deeply appreciated the care and compassion shown to Patrick and his entire family. When he died, they felt compelled to say "thank you" to nurses in a very public way. Please say thank you by sharing your story of how a nurse made a difference you will never forget!

	Date of Nomination:

	I would like to thank my nurse (name):

	Nursing Unit:

	Please describe a specific situation or story that demonstrates how this nurse made a meaningful difference in your care.

	Your Name:

	Telephone Number:

	Email Contact:

I am (please select one)

	Patient
	Friend/Family
	Caregiver: RN
	Caregiver: Provider
	Caregiver: Other

I would like to thank my nurse (name):