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2026 AHHC Physician of the Year Form

2026 Physician of the Year - Nominee Profile Form

CRITERIA FOR NOMINATION
This award is presented annually to a North Carolinian physician who has demonstrated a philosophical commitment to assisting home health and/or hospice patients who wish to remain at home.

Please be sure to address the qualities of the nominated individual that best meets the following criteria:

  • Describe role of this physician with your agency and how this physician actively supports your programs?
    • Willing to share knowledge (in-services)
    • Consultative services
    • Review Policies, Procedures, and Protocols
  • Describe how this physician serves as an advocate for in-home services in the community.
  • How has the physician served above and beyond call of duty or made a difference in the agency? Describe how well they collaborate with staff.

Do not use the name of the nominee or any identifying information (such as agency name) on your narrative or in your answers.
1.Name of Nominator
2.Agency of Nominator
3.Nominator's Phone
4.Nominator's Email
5.Nominee's Name, Title, and Credentials
6.Nominee's agency and address
7.Nominee's Email Address
8.Nominee's Phone Number
9.Number of Years Worked in Home Care and Hospice
10.Describe role of this physician with your agency and how this physician actively supports your programs?
• Willing to share knowledge (in-services)
• Consultative services
• Review Policies, Procedures, and Protocols
11.Describe how this physician serves as an advocate for in-home services in the community.
12.How has the physician served above and beyond call of duty or made a difference in the agency? Describe how well they collaborate with staff.
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