Nomination form for the Academy of Master Clinicians

Mission

The Academy of Master Clinicians at the Joan C. Edwards School of Medicine recognizes exemplary healthcare professionals who embody the highest standards of clinical excellence. These individuals are known for their clinical expertise, compassionate care, and unwavering commitment to patient well-being. The Academy promotes clinical excellence across Marshall Health, the Marshall Health Network, and the Cabell County Medical Society. Members are role models in patient care, professionalism, collegiality, and medical citizenship.

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* 1. Nominator's Name and Contact

Name

Your institution

Email Address

Phone Number

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* 2. Which entity are you nominating the clinician from?

Marshall Health

Marshall Health Network

Cable County Medical Society

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* 3. Please provide the nominee's full name

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* 4. Describe the nominee's clinical expertise and areas of specialization.

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* 5. Highlight the nominee's contributions to clinical excellence, mentorship, education, and patient outcomes.

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* 6. Select all the attributes that best describe the nominee. (Select all that apply.)

Clinical Excellence-Minimum of 15 years in clinical practice

Patient Care: Consistently provides equitable, high-quality care

Compassion: Demonstrates empathy toward patients and families

Reputation: Highly regarded by patients and colleagues alike

Patients Outcomes: Maintains excellent clinical outcomes, especially in complex cases

Patient Care: Consistently provides equitable, high-quality care

Mentorship: Actively mentors and educates future healthcare professionals

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* 7. Please provide any additional comments or endorsements for the nominee.

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* 8. Please upload the nominee's CV.

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* 9. Please upload the nomination letter (500-750 words). Describe the nominee’s clinical expertise, growth, and character. Highlight traits such as compassion, integrity, outcomes, and mentorship.

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* 10. Is the nominee a patient-facing clinician?

Yes

Nomination form for the Academy of Master Clinicians

Mission

Question Title

* 1. Nominator's Name and Contact

Question Title

* 2. Which entity are you nominating the clinician from?

Question Title

* 3. Please provide the nominee's full name

Question Title

* 4. Describe the nominee's clinical expertise and areas of specialization.

Question Title

* 5. Highlight the nominee's contributions to clinical excellence, mentorship, education, and patient outcomes.

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* 6. Select all the attributes that best describe the nominee. (Select all that apply.)

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* 7. Please provide any additional comments or endorsements for the nominee.

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* 8. Please upload the nominee's CV.

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* 9. Please upload the nomination letter (500-750 words). Describe the nominee’s clinical expertise, growth, and character. Highlight traits such as compassion, integrity, outcomes, and mentorship.

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* 10. Is the nominee a patient-facing clinician?

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* 11. If yes, please provide any patient testimonials that support the nominee's clinical excellence.

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* 12. If no, please provide any colleague endorsements that support the nominee's clinical excellence.