MAILING ADDRESS: 5781 Lee Boulevard, Unit 208-104, Lehigh Acres, FL 33971

PAGE 1 of 2 ---DIRECTIONS FOR
Annual Physician Medical Service Awards Nomination Form

Please e-mail (preferred) or simply mail the completed form by April 7th to the Lee County Medical Society (LCMS) at the address listed at the end of this form. Pertinent supplemental materials may be appended. All nominees must be US citizens and legal residents of Lee County. Nominees do not need to be members of the LCMS. Anybody can nominate! For Physician nominations, they must have practiced in the past or still have their practice located within Lee County.

Any nominations presented after the deadline will not be accepted and will have to be re-submitted to be considered for the following year.

Physician Award Categories:

Citizenship and Community Service Award
For outstanding leadership and/or public service above and beyond the call of duty as a practicing physician. This can include service within the local community or abroad, such as, but not limited to, contributions to international aid missions or other pro bono work.

Health Education Award
This award will recognize the professional or public health education activities of a physician. This may include those exemplary physicians who educate other physicians and health care workers. Physicians involved in non-promotional community service education will also be considered.

Leadership and Professionalism Award
This award will underscore the County Medical Society’s continuing dedication to the principles of medicine and the highest
standards of medical practice. The ideal candidate for the award would:

1. Have distinguished himself/herself as a leader in medicine within our community or beyond.
2. Have made an outstanding contribution through active service in the medical community, improving the profession’s effectiveness, upholding the practice of medicine through advocacy of policies, provision and/or the organization of services, and/or scholarly writings that demonstrate effective leadership and professionalism.

Lifetime Achievement Award
Nominees should have contributed substantially to the goals and ideals of the medical profession. The nominees' contributions shall have been sustained and substantial over a significant term of service in the respective County.

Non-Physician Award Categories:

Non-Physician Appreciation Award (i.e., nurses, nurse practitioners, physician assistants
and other medical staff)
For exemplary and a lasting impact to medicine above and beyond the call of duty, as a (non-physician) member of the medical
profession.

Distinguished Layperson’s Service Award (i.e., medical support staff, medical administration and medical education)
This award shall be made to an individual who has contributed to the achievement of the ideals of medicine through the advancement of medicine, medical science, medical research, medical education or medical care. This award includes those who support the medical profession through the delivery of medicine or medical research/education but are not themselves physicians, nurses, nurse practitioners, physician assistants or other medical staff.

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