The FAFP Family Physician of the Year is selected each year from among FAFP physician members in good standing who are directly and effectively involved in community affairs and activities that enhance the quality of life of the community. The award is provided in recognition of outstanding performance as a Family Physician in dedication to the profession and service to the patient. Nominees for Family Physician of the Year should:

Selection Criteria:
  • Embody the finest characteristics of family medicine;
  • Provides his/her patients with compassionate, comprehensive, and caring family medicine on a continuing basis;
  • Enhances the quality of his/her community by being directly and effectively involved in community affairs and activities;
  • Acts as a credible role model professionally and personally to his/her community, to other health professionals, and residents and medical students;
  • Stands out among his/her colleagues;
  • Can effectively represent the specialty of Family Medicine and the FAFP in public speaking;
  • Have at least five years of practice experience; and
  • Be a member in good standing within the community and of the American Academy of Family Physicians (AAFP) and the Florida Academy of Family Physicians (FAFP).
The nomination packet must contain the following:
  • Current curriculum vitae (limited to three pages).
  • Maximum of eight pages of supporting documentation.
    • Please note the following rules: If more than eight pages are received, only the first eight pages will be used. Note: supporting documentation does not include the nomination form or curriculum vitae.
    • No double-sided pages will be accepted.
    • Please do not reduce more than two letters to a page. Nomination packets with more than two letters per page will not be accepted.
    • All pages must be photocopy-ready and of reproducible quality. Newspaper articles, odd-sized pieces of paper, etc., must be copied onto an unfolded, 8 1/2 x 11 sheet of paper. Anything that is not photocopy-ready will not be used.
  • Photograph 5x7 print or higher (high quality/professional images only)
The application and supporting documents (as noted above) must be sent together in this application and received at FAFP no later than August 30, 2019.  Questions, please contact Jennifer Young at jyoung@fafp.org or (904) 726-0944.

Question Title

* 1. Name of individual completing application (include email address):

Question Title

* 2. Physician Nominee Name:

Question Title

* 3. Physician AAFP/FAFP Member ID:

Question Title

* 4. Physician Date of Birth:

Date

Question Title

* 5. Physician Home Address (include address, city, state and zip code):

Question Title

* 6. Physician Home Phone Number:

Question Title

* 7. Physician Office Address (include address, city, state and zip code):

Question Title

* 8. Physician Office Phone Number:

Question Title

* 9. Physician Email address:

Question Title

* 10. Physician Residency Program:

Question Title

* 11. Board Certified in Family Medicine:

Question Title

* 12. Total Years in Practice:

Question Title

* 13. Practice Type

Question Title

* 14. Is the physician's practice recognized as a patient-centered medical home?

Question Title

* 15. Please describe how the physician exhibits the following criteria:

Provides his/her patients with compassionate, comprehensive, and caring family medicine on a continuing basis:

Question Title

* 16. Is directly and effectively involved in community affairs and activities that enhance the quality of his/her community:

Question Title

* 17. Acts as a credible role model professionally and personally to his/her community, to other health professionals, and residents and medical students:

Question Title

* 18. What one characteristic makes this person stand out among his/her colleagues:

Question Title

* 19. Please upload a copy of the physician's CV for review (limited to 3 pages):

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File

Question Title

* 20. Physician's Personal Statement (if applicable):

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File

Question Title

* 21. Please upload copies of supporting documentation (letters of support up to 8 pages)

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File

Question Title

* 22. Please upload professional physician photograph (5x7 high quality)

GIF, JPEG, JPG, PNG file types only.
Choose File

T