Nomination Survey for Annual CCPM Awards

As part of our commitment to recognizing and celebrating excellence across the CCPM network, we invite you to nominate individuals at our member organizations who have demonstrated outstanding contributions in the areas of collaboration, care-delivery innovation, quality improvement, patient-centered care, and CCPM engagement.

Please take a few minutes to complete the following survey to nominate deserving candidates. Your input will play a crucial role in acknowledging the efforts of those who have made a significant impact in these important areas.

1.Nominee Information:(Required.)

Name of individual or organization

Title (Please choose CEO if nominating an organization)

Contact information (email address)

2.Award Nominating For: (Please select one or more)(Required.)

Care Delivery Innovation Award - This is awarded to an individual who displays dedication to innovative care delivery at their organization.

Quality Improvement Champion Award - This is awarded to an individual committed to continuous quality improvement.

Patient-Centered Care Award - This is awarded to a care team member committed to delivering patient-centered, individualized and evidence-based care.

CCPM Engagement Award - This is awarded to an individual who demonstrates exceptional commitment to CCPM initiatives and partnership with CCPM staff to make them successful.

Mary Prybylo Collaboration Award - This is awarded to an individual who embodies Mary Prybylo’s collaborative spirit and commitment to advancing population health.

3.Description/Reason for Nomination:
Please provide a brief description of the nominee's achievements and contributions in the selected category/categories. Feel free to include specific projects, initiatives, or examples that highlight their impact.(Required.)

4.Your Name:(Required.)