GHXcellence Awards Nomination Form

Submission deadline: January 18, 2019

Submitter Information

First Name *

Last Name *

Title

Email *

Phone

Award Information

Nominated Organization or Leader

Name of Organization *

Contact First Name *

Contact Last Name *

Contact Title *

Contact Email *

Contact Phone

GHX Account Manager *

Nominated Organizations (for trading partner pair of the year)

Name of Provider Organization *

Provider Contact First Name *

Provider Contact Last Name *

Provider Contact Title *

Provider Contact Email *

Provider Contact Phone

GHX Account Manager - Provider *

Name of Supplier Organization *

Supplier Contact First Name *

Supplier Contact Last Name *

Supplier Contact Title *

Siupplier Contact Email *

Supplier Contact Phone

GHX Account Manager - Supplier *

Nomination Details

GHX product(s) in use *

Describe why this nominee should be considered for this award (primary reasons) *

Describe why this nominee should be considered for this award (other reasons)

Present relevant data and metrics that support the nomination, based on the criteria presented on the individual award page *

Other relevant information

Supporting Attachments