RR Hannas Physician Nomination Form

Nominator Information

Please complete this section as the individual submitting a nomination.

Nominee Information

Please complete this section about the physician you are nominating. All nominees must be an active member of MOCEP. To check membership status of a physician please contact Sarah Luebbert, sarah@mocep.org.

Tell us why you are nominating this individual for the RR Hannas Physician Award?

Please provide any background information that may be beneficial to the nominee (limit of 500 words). Attributes which may be considered include: • Compassionate patient care with high levels of patient satisfaction • Community Service • Collaboration with nurses, EMT’s, and ancillary hospital staff • Advancement of emergency medicine through teaching, involvement in hospital activities or organized medicine

Additional Information:

Please upload the nominees CV along with additional information (up to 3 documents total), such as letters of recommendation, news articles, etc., that you would like to submit with your nomination. Thank you for your nomination!
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