The Invaluable Medical & Dental Assistant Award

Call for Nominations

Purpose of the Award

The purpose of this award is to recognize and honor an outstanding Medical Assistant and an outstanding Dental Assistant each of whom have demonstrated having a significant impact on the care your patients receive and on the quality of your health center. This Call for Nominations provides you with the opportunity to recognize the exceptional work your nominee does in contributing to the value of health care in their respective community health centers.

Instructions for Completing the Nomination Application

Please complete the attached application and forward to Brenda Cardenas at fax #602-252-3620 or email at . Only one application per health center department will be accepted. For example, if your organization has multiple locations with multiple departments such as family practice, dental, pediatrics, internal medicine and gynecology, only one application will be accepted for each department, not for each location. The applicant must be evaluated in all of the following areas:

1. Clinical Knowledge and Skills

2. Community Health Center Impact

3. Patient Care Services

4. Accomplishments

Incomplete nominations will not be given consideration.

Please include brief, detailedexamples and descriptions for each area (you may attachsupporting documents).

Questions regarding this award should be addressed to:

Brenda Cardenas

Phone: 602.218.3919  Fax: 602.252.3620

Thank you for supporting our outstanding Medical and Dental Assistants by submitting a nominee for consideration.

The Invaluable Medical/Dental Assistant Award Application

Directions: Please complete each section of the application. If you need more space, please attach additional pages. Only one application per health center department will be accepted. For example, if your organization has multiple locations with multiple departments such as family practice, dental, pediatrics, internal medicine and gynecology, only one application will be accepted for each department, not for each location.

Nominee
  • Name
/ ______
  • Title
/ ______
  • Place of Employment
/ ______
  • Length of Employment
/ ______
  • Years at a CHC
/ ______
  • Supervisor
/ ______
  • Supervisor’s Contact Information
/ ______
  • Medical/Dental Director
/ ______
  • Medical/Dental Director Contact Information
/ ______
  • CEO
/ ______
  • CEO’s Contact Information
/ ______
Nominator
  • Name
/ ______
  • Title
/ ______
  • Contact Information
/ ______

Evaluation

  1. Clinical Knowledge and Skills

Please tell us about a time when your nominee exceeded expectations in performing clinical responsibilities or when they demonstrated clinical expertise in order to improve patient care.

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The Invaluable Medical/Dental Assistant Award Application

Page 2

  1. Community Health Center Impact

Please provide a specific example of how your nominee’s efforts have made a positive difference for the patients and to the community health center.

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  1. Patient Care Services

Please provide an example on how your nominee has gone above and beyond to meet or exceed the patients care expectations.

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  1. Accomplishments

Please write a brief description, using specific examples, ofaccomplishments your nominee has achieved that lead you to believe that your nominee is unique and exceptional.

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