NETRC 2022 Conference- Michael Edwards Memorial Award Nomination Form

The Michael Edwards Memorial Award for Advancing Telehealth in the Northeast is presented annually to an individual or organization in the Northeast Region (New England and New York) that has been a part of innovative and impactful efforts to increase telehealth utilization. Extra consideration is given towards applicants working within telehealth avenues that were near and dear to our colleague Michael Edwards, including:

Community Health Center/Federally Qualified Health Center/ Rural Health Center Based
Skilled Nursing Facility Based
Focused in Rural Areas
Telehealth Research or Innovation
Population Health

The first award was given to Maureen Donovan, M.ED in 2021, for her work with School Based Telehealth Efforts in Rural MA.

2022 Nominations opened on June 7th, 2022 and will close on Wednesday July 27, 2022.

The 2022 award has been made possible via generous support from our colleagues at Zoom.

Question Title

* 1. Contact Information of Nominating Individual (your name)

Name *

Company *

Address

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number

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* 2. Contact Information of Nominee (Award Candidate)

Name *

Company *

Address

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number

NETRC 2022 Conference- Michael Edwards Memorial Award Nomination Form

Question Title

* 1. Contact Information of Nominating Individual (your name)

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* 2. Contact Information of Nominee (Award Candidate)

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* 3. Please describe how the nominee has been a leader in leveraging telehealth to improve access to care

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* 4. Please Describe the patient population reached/served with the efforts above

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* 5. Please add any other comments or noteworthy outcomes & highlights of the nominee's efforts that will help inform the Selection Committee Decision