ONLINE NOMINATION FORM The Online nomination Form [] 1 NOMINATION FORM (Kindly tick only ONE sub- category and Attach additional sheets / informationwherever required)Nomination is on-going NameFull Name of Nominatorno-icon Telephone Number:icon-phone Emaila valid emailemail AWARD CATEGORIES (Kindly tick only ONE sub- category and Attach additional sheets / informationwherever required) A. SPECIAL AWARDSLifetime Achievement Award Special Recognition AwardOutstanding State Government Healthcare Programme of the YearOutstanding CSR Health Project of the year Outstanding Healthcare Project Friendly Financial Institution of the Year Outstanding Healthcare SME Friendly Financial Institution of the Year Healthcare Media Excellence Award-PrintHealthcare Media Excellence Award-OnlineHealthcare Media Excellence Award- Broadcast OR B. HEALTHCARE DELIVERY SERVICESPrivate Healthcare Provider of the yearPrivate Laboratory Service Provider of the yearRadiology Service Provider of the yearHealth Maintenance Organization of the yearInnovative Healthcare Service Provider of the yearPharmAccess SafeCare Facility of the YearIVF Service Provider of the YearDialysis Service Provider of the yearEye Care Service Provider of the yearDental Service Provider of the yearPhysiotherapy Service Provider of the yearTertiary Healthcare Provider of the yearNursing and midwifery Excellence Awards OR C. BIOMEDICAL TECHNOLOGYLaboratory Equipment Marketing Company of the YearBiomedical Engineering Service Company of the YearHospital Equipment Marketing Company of the year OR D.PHARMACEUTICALSPharmaceutical Retail Outlet of the YearPharmaceutical Manufacturing Company of the yearTechnology-Driven Pharmaceutical Distributor of the YearMost Improved Pharmaceutical Retail Outlet of the Year DETAILS OF NOMINEE Full Name(Individual or Organization)icon-user Designationno-icon Postal Addressno-icon Telephoneno-icon Mobileicon-phone Emailsemail Websiteicon-globe REASON(S) FOR NOMINATION: Please describe your experience, uniqueness / novelty of the facility or service provider or contribution of nominee and the reason(s) for your nomination. expce 0 / Submit Form Previous Next FormCraft - WordPress form builder
