Pulmonary, Critical Care and Sleep Medicine

Nominate An Outstanding Respiratory Therapist for the PHIL Award

First Name

Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Phone Number

E-mail Address

Your Role

Would you and/or your family be willing to present this award?

Yes

Respiratory Therapist Name

Where does this respiratory therapist work? (Example: Department, unit, or area of the hospital.)

Please provide details of how a respiratory therapist has provided professional excellence and compassion in the education and care of a specific and/or family dealing with pulmonary illness:

Please choose one:

I authorize my name to be used in hospital recognition materials for this respiratory therapist.

I do not authorize my name to be used in hospital recognition materials for this respiratory therapist.