2019 Practice Manager of the Year Nominating Form

Question Title

* 1. Nominee Name and Email Address:

Name

Email Address

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* 2. Leadership: (Rate 1-5 with 5 being the highest)

	1	2	3	4	5
Sets a positive example and motivates others "Leads by Example"	Sets a positive example and motivates others "Leads by Example" 1	Sets a positive example and motivates others "Leads by Example" 2	Sets a positive example and motivates others "Leads by Example" 3	Sets a positive example and motivates others "Leads by Example" 4	Sets a positive example and motivates others "Leads by Example" 5
Fosters an open and positive work environment	Fosters an open and positive work environment 1	Fosters an open and positive work environment 2	Fosters an open and positive work environment 3	Fosters an open and positive work environment 4	Fosters an open and positive work environment 5
Supports staff members	Supports staff members 1	Supports staff members 2	Supports staff members 3	Supports staff members 4	Supports staff members 5
Maintains and boosts morale through programs and activities	Maintains and boosts morale through programs and activities 1	Maintains and boosts morale through programs and activities 2	Maintains and boosts morale through programs and activities 3	Maintains and boosts morale through programs and activities 4	Maintains and boosts morale through programs and activities 5

Briefly describe why you ranked this applicant as you did:

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* 3. Management: (Rate 1-5 with 5 being the highest)

	1	2	3	4	5
Initiates and sustains financial growth within the organization	Initiates and sustains financial growth within the organization 1	Initiates and sustains financial growth within the organization 2	Initiates and sustains financial growth within the organization 3	Initiates and sustains financial growth within the organization 4	Initiates and sustains financial growth within the organization 5
Manages and/or decreases costs whenever possible without sacrificing service	Manages and/or decreases costs whenever possible without sacrificing service 1	Manages and/or decreases costs whenever possible without sacrificing service 2	Manages and/or decreases costs whenever possible without sacrificing service 3	Manages and/or decreases costs whenever possible without sacrificing service 4	Manages and/or decreases costs whenever possible without sacrificing service 5
Identifies new revenue sources through products and services	Identifies new revenue sources through products and services 1	Identifies new revenue sources through products and services 2	Identifies new revenue sources through products and services 3	Identifies new revenue sources through products and services 4	Identifies new revenue sources through products and services 5
Increases efficiency through processes and systems	Increases efficiency through processes and systems 1	Increases efficiency through processes and systems 2	Increases efficiency through processes and systems 3	Increases efficiency through processes and systems 4	Increases efficiency through processes and systems 5
Able to identify and resolve revenue issues	Able to identify and resolve revenue issues 1	Able to identify and resolve revenue issues 2	Able to identify and resolve revenue issues 3	Able to identify and resolve revenue issues 4	Able to identify and resolve revenue issues 5
Excels in conflict resolution	Excels in conflict resolution 1	Excels in conflict resolution 2	Excels in conflict resolution 3	Excels in conflict resolution 4	Excels in conflict resolution 5
Delegates responsibilities when necessary	Delegates responsibilities when necessary 1	Delegates responsibilities when necessary 2	Delegates responsibilities when necessary 3	Delegates responsibilities when necessary 4	Delegates responsibilities when necessary 5

Briefly describe why you ranked this applicant as you did:

Question Title

* 4. Customer Service: (Rate 1-5 with 5 being the highest)

	1	2	3	4	5
Promotes excellent customer service throughout the office	Promotes excellent customer service throughout the office 1	Promotes excellent customer service throughout the office 2	Promotes excellent customer service throughout the office 3	Promotes excellent customer service throughout the office 4	Promotes excellent customer service throughout the office 5
Initiates stellar patient experience	Initiates stellar patient experience 1	Initiates stellar patient experience 2	Initiates stellar patient experience 3	Initiates stellar patient experience 4	Initiates stellar patient experience 5
Builds a solid rapport with patients	Builds a solid rapport with patients 1	Builds a solid rapport with patients 2	Builds a solid rapport with patients 3	Builds a solid rapport with patients 4	Builds a solid rapport with patients 5
Creates an office atmosphere that patients enjoy coming to	Creates an office atmosphere that patients enjoy coming to 1	Creates an office atmosphere that patients enjoy coming to 2	Creates an office atmosphere that patients enjoy coming to 3	Creates an office atmosphere that patients enjoy coming to 4	Creates an office atmosphere that patients enjoy coming to 5
Resolves patient complaints quickly and efficiently	Resolves patient complaints quickly and efficiently 1	Resolves patient complaints quickly and efficiently 2	Resolves patient complaints quickly and efficiently 3	Resolves patient complaints quickly and efficiently 4	Resolves patient complaints quickly and efficiently 5
Goes the "extra mile" to help patients with billing issues	Goes the "extra mile" to help patients with billing issues 1	Goes the "extra mile" to help patients with billing issues 2	Goes the "extra mile" to help patients with billing issues 3	Goes the "extra mile" to help patients with billing issues 4	Goes the "extra mile" to help patients with billing issues 5
Ability to balance the needs of the patients while responding to employee concerns and questions	Ability to balance the needs of the patients while responding to employee concerns and questions 1	Ability to balance the needs of the patients while responding to employee concerns and questions 2	Ability to balance the needs of the patients while responding to employee concerns and questions 3	Ability to balance the needs of the patients while responding to employee concerns and questions 4	Ability to balance the needs of the patients while responding to employee concerns and questions 5

Briefly describe why you ranked this applicant as you did:

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* 5. Above and Beyond (Rate 1-5 with 5 being the highest)

	1	2	3	4	5
Assisted a patient in a way that goes beyond "normal" customer service	Assisted a patient in a way that goes beyond "normal" customer service 1	Assisted a patient in a way that goes beyond "normal" customer service 2	Assisted a patient in a way that goes beyond "normal" customer service 3	Assisted a patient in a way that goes beyond "normal" customer service 4	Assisted a patient in a way that goes beyond "normal" customer service 5
Has gone above and beyond for the office or staff members	Has gone above and beyond for the office or staff members 1	Has gone above and beyond for the office or staff members 2	Has gone above and beyond for the office or staff members 3	Has gone above and beyond for the office or staff members 4	Has gone above and beyond for the office or staff members 5

Briefly describe why you ranked this applicant as you did:

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* 6. Is there something else that stands out about this person? Please note reasons why they should be 2019 Practice Manager of the Year below.

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* 7. Submitted by: Your Name, Company, Email Address, and Phone:

Name

Company

Email Address

Phone Number

Thank you for submitting your application.
Please submit by January 11, 2019.