PBHN EMS Excellence Award Nomination

Please answer each question to the best of your ability and the EMS Awards Committee will review.

If you have any questions about this process or would like clarification on any nominations, please email [email protected]

* indicates a required field

What EMS Agency does the crew/person being nominated work for? *

Please provide your department email address

Please select the date of service:

Please write below the account # for the patient associated with the nomination for award:

What EMS Agency does the crew/person being nominated work for? (If unknown, select other and provide any details you can to identify the Rescue Unit)

For Other please specify:

Please write a short description of how the crew or individual, while following protocols, exercised exceptional treatment, while advocating for the patient and family while displaying a high level of professionalism.