The Daisy PETAL Award

The DAISY PETAL Award nomination form

This Patient Care Technician’s clinical skill and especially her/his compassionate care exemplify the kind of Patient Care Technician that our patients, their families, and our staff recognize as an outstanding role model.

All fields with an asterisk (*) are required.

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2022-FW-Good Samaritan Hospital-DAISY PETAL-PI

The Patient Care Technician you are nominating*

First Name

Last Name

Patient Care Technician's Unit/Department*

Please share your story that demonstrates how this Patient Care Technician made a meaningful difference.*

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

Please tell us about yourself

Your name*

First Name

Last Name

I am:*

Date

How do we reach you?

Phone