Please fill out the form below to nominate a meritorious individual for the Patient Safety Award. You may also email your nomination to awards@theoma.org if you prefer. If you have any questions, please email Kris Bilderback, Executive Assistant to the CEO, at kris@theoma.org. Additional information about our awards can be found here: OMA Awards

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* 1. Please provide your contact information

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* 2. Please provide the contact information of the nominee

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* 3. George E. Miller Patient Safety Award: Do you know a physician, healthcare provider, healthcare professional or community member who has given exemplary leadership, innovation and commitment to patient safety? If so, we encourage you to nominate the candidate for the OMA’s Patient Safety Award. Named after George E. Miller MD, a pediatrician who epitomized compassionate care and service to his community, this award recognizes someone who has provided:
* Leadership in promoting and implementing safe patient care
* Innovation in patient safety and quality
* Commitment to significant and sustainable improvements in patient care

Please explain why your nominee is deserving of this award. Specific examples of professional and civic accomplishments will assist the selection committee in identifying the award recipient.

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* 4. Please attach a bio, resume, or CV for your nominee.

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* 5. Alternate: Paste a bio or CV here

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