Award Nomination: Innovative Health-System Pharmacy Practice Award

Please provide the information requested below. You may also upload supporting documents using this form.

● Award Description/Criteria
● List of Awards
● Past Recipients

* = Required Field
YOUR NAME*
First Last
YOUR EMAIL ADDRESS*
YOUR PHONE NUMBER*
INSTITUTION AND DEPARTMENT OF THE PHARMACY STAFF YOU ARE NOMINATING*
DIRECTOR OF THE PHARMACY STAFF YOU ARE NOMINATING*
First Last
DIRECTOR'S EMAIL ADDRESS*
DIRECTOR'S PHONE NUMBER*
Please comment on the applicable areas below, with regard to the pharmacy staff you are nominating.
ADVANCES WITHIN THE PAST 24 MONTHS:
CLINICAL SERVICES/DISEASE MANAGEMENT:
PATIENT EDUCATION ACTIVITIES:
PHARMACY STAFF EDUCATION ACTIVITIES:
HEALTH CARE PROFESSIONAL EDUCATION ACTIVITIES:
COMMUNITY EDUCATION ACTIVITIES:
RESEARCH/INVESTIGATIONAL ACTIVITIES:
OUTPATIENT SERVICES - AVERAGE DAILY OUTPATIENT CENSUS:
DRUG DISTRIBUTION (AUTOMATION/EQUIPMENT):
STAFF SIZE FTEs/HOURS OF OPERATION:
AVERAGE DAILY CENSUS/NUMBER OF BEDS, IF APPLICABLE:
WHY DO YOU THINK THIS PHARMACY STAFF DESERVES THIS RECOGNITION?
SUPPORTING FILE(S)
Below, you may upload documentation in support of the pharmacy staff you are nominating for the Innovative Health-System Pharmacy Practice Award.
Drop files here or

Max. file size: 256 MB.