2022 Health Information Management Nomination

Name: Colorado Health Care Association
Address: 4100 E. Mississippi Ave. Suite 925, Glendale, CO, 80246
Telephone: 303-861-8228

2022 Spotlight on Excellence Nomination-Health Information Management Form

Name of Nominee*
Job Title*
Number of Years in Current Position*
Number of Years With the Facility*
Number of Years in the Long Term Care Industry*
Community/Facility Name*
Who Is Nominating This Person?*

*Contact Person-Person Submitting the Form*
Nominator's Email Address*
Nominators Phone Number*
Secondary Contact Person*
Secondary Contact Person Email*
Secondary Contact Person's Phone*
Facility Address*
Facility Phone Number*
Short Answer 1: Describe what the nominee does above and beyond to promote and enhance the quality of life for the residents of your facility.*
100 words or less
Short Answer 2: Describe how the nominee goes above and beyond to enhance overall operations in the facility and throughout the community.*
100 words or less
Short answer 3: Paint a word picture to describe why your nominee should be a Spotlight on Excellence Award winner.*
100 words or less
Short Answer 4: Please describe any other attributes of this individual that explain why they should receive the "Spotlight on Excellence" award recognition.*
Reference Letter Number 1*
Accepted file types: pdf, doc, docx, Max. file size: 21 MB.
Letters can come from staff, family members, managers, or outside sources.
Letter should be from someone who knows the nominee professionally.
Letter should be dated, and have a proper signoff, including:
Name
Title
Company
Please refrain from listing identifying information within the recommendation letters.
Reference Letter Number 2*
Max. file size: 2 MB.
Letters can come from staff, family members, managers, or outside sources.
Letter should be from someone who knows the nominee professionally.

IMPORTANT: Nominee's name should not appear in the letter.

Letter should be dated, and have a proper signoff, including:
Name
Title
Company
Please refrain from listing identifying information within the recommendation letters.
Picture*
Accepted file types: jpg, png, , Max. file size: 2 MB.
One (1) High Quality Photo of the Nominee

2022 Health Information Management Nomination

2022 Spotlight on Excellence Nomination-Health Information Management Form

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