Daisy Award Nomination

	Your information:

I am a:*

	The nurse I want to recognize:

	example: example: Emergency, Labor & Delivery, etc.

	Here is the Story:

Our nurses can be recognized and honored for showcasing the following character traits:*

	P - passion and compassion
	E - empathy in the situation
	T - trust and teamwork of families, patients and peers
	A - admirable attributes possessed
	L - love for the patient and nursing profession
	S - selflessness

	Please tell us your story about how your nurse demonstrated the characteristics above and is deserving of the DAISY Award

	May we share or publish your comments for employee recognition?*
	Yes No