Nominate A Nurse - Covington Trace ER & Hospital

contact name organization

First name of the nurse you are nominating

Last name of the nurse you are nominating

Additional team members (if nominating for Team Award)

List names separated by commas (example, Jane, Joe)

Name of organization where your nurse works

Please include specific hospital, emergency room, or campus name

Location where care was provided

Room number or unit, department, or facility name

Date(s) care was provided

City where your nurse works

State where your nurse works

Tell us your story

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

Where did you learn about DAISY?

Your name

Phone

I am a

May we contact you if we have questions about your nomination?