The DAISY Award

The DAISY Award is an international program that rewards and celebrates the extraordinary compassionate and skillful care given by nurses every day. Good Samaritan Hospital is proud to be a DAISY Award Partner, recognizing our nurses with this special honor quarterly. DAISY Award honorees personify Good Samaritan Hospital's remarkable patient experience. These nurses consistently demonstrate excellence through their clinical expertise and extraordinary compassionate care. And, they are recognized as outstanding role models in our nursing community.

Each DAISY Award nominee will be recognized with a DAISY nominee pin and congratulatory letter from our Chief Nursing Officer. Our DAISY Award winners will be surprised at a celebration where they will be presented a certificate, a DAISY Award pin, and a hand-carved stone sculpture entitled A Healer's Touch.

How To Nominate A Nurse

Anyone may nominate a deserving nurse by filling out the below online form or a paper form located at one of our DAISY Award collection boxes located throughout the hospital. For questions about the DAISY award at Good Samaritan Hospital, please contact (408) 879-5738.

The DAISY Award nomination form

All fields with an asterisk (*) are required.

Thank You

The form was submitted successfully.

Please fill in a valid value for all required fields

Please ensure all values are in a proper format.

Are you sure you want to leave this form and resume later?

Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.

Save and Resume Later

Save and get link

You must upload one of the following file types for the selected field:

There was an error displaying the form. Please copy and paste the embed code again.

Apply Discount

You saved

with code

Submit Form

Submitting

Validating

There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.

Please check the field:

Fields

The nurse you are nominating*

First Name*

Last Name*

Nurse's unit*

Please share your story that demonstrates how this nurse made a meaningful difference.*

Thank you for taking the time to nominate an extraordinary, compassionate nurse for this award. Please tell us about yourself, so we can include you in the celebration of this award, if the nurse you nominated is chosen.

Please tell us about yourself

Your name*

First Name*

Last Name*

I am:* (select one) Patient Family/Visitor MD Staff Volunteer

Please select one

Date*

https://www.formstack.com/forms/images/2/calendar.png

Month

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Day

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Year

2019 2020 2021 2022 2023 2024

How do we reach you?

Phone

Email

---

General Internet communication is inherently not secure. DO NOT send data considered confidential or private in nature on this form. (e.g., Social Security Numbers, Diagnosis Information, Credit Card Numbers, etc.)

Previous← Next→

Enter your save and resume password

Cancel

Confirm