Peninsula Regional Medical Center - Part of Peninusula Regional Health System


DAISY Award Nomination ONLINE Form



Tell us about the nurse you are nominating as a deserving recipient of The DAISY Award. This nurse’s clinical skill and especially her/his compassionate care exemplify the kind of nurse that our patients, their families, and our staff recognize as an outstanding role model.  She/he consistently meets all of the following criteria: Must be an RN (registered nurse) or LPN (licensed practical nurse) involved in direct patient care.



* Indicates required information
Candidate’s Name * 
Unit/Department * 
Please describe a situation or story involving the nurse you are nominating that clearly demonstrates he/she meets the criteria for The DAISY Award. 
 * 
Thank you for taking the time to nominate an extraordinary, compassionate nurse 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 is chosen. 
Nominated by (your name) * 
Unit 
Phone 
E-mail 
I am (Please mark one): * 




If Other, please specify:

Date *  (mm/dd/yyyy)
Authentication * 

If the challenge words are too difficult to read, click here to refresh.
 

Nominations received by the 15th of the month will be considered for the following month’s DAISY Award.