HCHB Customer Awards: Industry Advocate Nomination Form

HCHB Customer Awards:

Industry Advocate Nomination Form

The Industry Advocate award honors the contributions of specific individuals for excellence in patient care, performance, innovation, regulatory affairs, or other areas. We look forward to learning more about your nominee.

Learn more about our HCHB Customer Awards here.

*All nominees must be from an organization currently using HCHB.

Nominator Information

Nominator's Full Name*

First and Last Name

Nominator's Email Address*

Nominator's Agency Name*

Name of the agency you are employed at.

Nominee Information

Nominee's Full Name*

First and Last Name

Nominee's Email Address*

Nominee's Agency Name*

Name of nominee's agency they are employed at.

Nominee's Job Title*

Reason for Nomination*

Describe your nominee's contributions as an advocate in our industry, highlighting their impact in areas such as patient care, performance, innovation, or regulatory affairs.

Relevant Publicity and News Coverage

If applicable, provide hyperlinks to any relevant media coverage we should consider for your nomination.

Upload Supporting Documents

If applicable, upload any relevant material we should consider for your nomination.

Drag and drop files here or

Leadership Contact Information

Manager's Full Name*

First and Last Name of nominee's manager.

Manager's Email Address*

Release of Information

Opt In for Permission*

I release and grant Homecare Homebase authorization to reproduce, copyright, exhibit, broadcast, electronic storage and/or distribution of said text/photographs/film/video tapes/electronic representations, and/or sound recordings without limitation at the discretion of Homecare Homebase.

Company Description/Boilerplate

Short description of nominee's agency.

Company Website Link*

Include the link to your company's website.

Send me a copy of my responses

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