2019 Patient Impact Award

Nomination Form

LSPA's Patient Impact Award recognizes a medicine, therapy, device, company or organization that made a significant contribution to the quality of healthcare or length of life of patients in 2019. Eligible organizations include medical device, diagnostic, pharmaceutical, biotechnology companies or research institutions with significant operations in Pennsylvania. The honored organization will be selected by a committee of leaders from Pennsylvania hospital groups from nominations provided by individuals in Pennsylvania’s life science community.

Please submit all nominations by 5pm on Monday, December 9, 2019. The top finalists will be recognized at Life Sciences Pennsylvania's 2020 Annual Dinner, scheduled for March 19, 2020 at the Pennsylvania Convention Center in Philadelphia, PA.

Contact Melissa Callum at mcallum@lifesciencespa.org with questions regarding the Patient Impact Award nomination process or award.

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* 1. Nominator Contact Information

First and Last Name: *

Organization:

State:

Country:

Email Address: *

Phone Number: *

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* 2. Nominee Information

Nominee First and Last Name: *

Nominee Organization:

Product:

Address:

City/Town:

State:

Nominee Email Address:

Nominee Phone Number:

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* 3. Reasons for Nomination: Please provide information to support your recommendation, include any information that will help the selection committee evaluate the qualifications of the nominee (testimonials, statistical information, etc.).