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Your Name
Your Nurse's Name
When was this care received?
Unit
I am:
RN
Patient
Family/Visitor
MD
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Volunteer
Describe the situation or story involving this nurse:
Describe the situation or story involving this nurse that clearly demonstrates he/she meets the following criteria: Dedication, Exemplifies Excellence Always, Serves as a role model, Shows extraordinary compassion & skills, Generates enthusiasm and energy toward meeting the challenges of nursing.
