2024 Harwick Innovation Nomination Form

The award is designed to recognize and celebrate the success of an individual who has developed an innovative solution that positively impacts practices, providers and/or patients in their community.

Please note: Current MGMA board members are not elgibile for nomination or for nominating. Only completed applications will be evaluated.

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* 1. Name of Nominator

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* 2. Title/Position

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* 3. Email address

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* 4. Organization

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* 5. Street Address

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* 6. City, State and Zip Code

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* 7. Phone number

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* 8. Name of Nominee

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* 9. Title/Position

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* 10. Organization

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* 11. Street Address

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* 12. City/State/Zip Code

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* 13. Phone number

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* 14. In general terms, please describe the justification for this nomination.

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* 15. Please describe in detail why and/or how the innovative solution was designed including a clear method, structure, and overview of resources utilized to achieve a positive outcome for a practice, provider or patient population.

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* 16. In general terms, please describe the originality of the solution and how it supports MGMA’s mission to transform healthcare.

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* 17. Please describe in detail how the individual has inspired others to positively impact the transformation of healthcare in his/her community

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* 18. Please describe in detail why the originality of the solution and how it supports MGMA’s mission to transform healthcare

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* 19. In general terms, please describe how the innovative solution empowers others in healthcare to make positive impacts in their community.

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* 20. Please describe in detail how the innovative solution empowers others in healthcare to make positive impacts in their community.

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* 21. Please provide documentation for this nomination justification (ie., metrics, pictures, processes, awards, etc.)

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