Nomination Form

Please complete the nomination form below to nominate your candidate for the Ozturk Financial 2023 Patient Choice Award.

Eligibility Criteria:

1. Nominated by a patient(s) or non-pharmacist colleague.
2. Delivered outstanding patient care and customer service.
3. Has made a lasting impact on patient outcomes.
4. Has made a significant impact on community health and wellness.
5. Self-nominations are accepted for this award.
6. Nominee cannot be on Pharmacists Manitoba’s Award Committee.
7. The Nominee cannot previously have won this award.
8. This award is not presented posthumously.
9. Submissions for this award must be in the hands of the Board of Directors prior to end of day on March 15, 2023.
10. The award will be presented at a time deemed appropriate by the Board of Directors of Pharmacists Manitoba.
11. Power of decision for granting the award rests with the Board of Directors of Pharmacists Manitoba.
12. The Patient Choice Award is not necessarily granted every year.

Nomination Details:

The nomination should include the following information:

1. A completed nomination form by the patient or non-pharmacist.
2. Documentation of no more than 1,000 words to include, but not limited to:
   1. A specific description of how the nominee has delivered outstanding patient care and customer service
   2. How this contribution has made a lasting impact on patient outcomes
   3. How this has significantly impacted community health and wellness
   4. Inclusion of evidence from patient or non-pharmacist colleague which supports one or more of the award criteria