NAME OF NOMINEE: ________________________________________________________
ORGANIZATION REPRESENTED: ____________________________________________
ADDRESS: __________________________________________________________________
____________________________________________________________________________
DAYTIME PHONE NUMBER: _________________________________________________
YOUR NAME: _______________________________________________________________
YOUR DAYTIME PHONE NUMBER: __________________________________________
Please list the reasons you feel this individual should be nominated as Patient Advocate of
the year. Please list specific examples, experience, stories or accomplishments. Please
include both hospital/ health care experience as well as any government or community
service they may have. Please feel free to include attachments.
Please fax this nomination form & attachments no later than May 2, 2008 to:
Attn: Marti Samsel
Sparrow Health System
(517) 364-3817
or email: marti.samsel@sparrow.org
Michigan Chapter – Society of Healthcare
Consumer Advocacy of the American
Hospital Association (MCSHCA)
April 1, 2008
Dear Healthcare Leader,
I am writing to you today regarding a wonderful opportunity to reward your hospital/
organization’s patient advocate. Patient Advocates may have different titles: Patient
Representative, Patient Advocate, Recipient Rights Coordinator, Social Worker, but one thing
they do is dedicate themselves to the advancement of patient care.
The Michigan Chapter Society of Healthcare Consumer Advocacy is offering the opportunity to
reward one individual as “Patient Advocate of the Year” for 2008. This is award will be
presented at our annual conference, this year held at Frankenmuth, Michigan on May 8 & 9. The
award winner will receive a special award along with a gift certificate and will be given free
registration to the conference. Please feel free to visit our website @
http://www.oocities.org/mcshca/
We are seeking candidates with outstanding experience and accomplishments in the
advancement of:
o Patient Education
o Patient Rights
o Ethics
o Patient Satisfaction/ measurement
o Customer Complaint Management
o Customer Service
Please feel free to include specific stories and characteristics exemplified by this candidate.
Special consideration will be given to those current members of the organization, but it is not a
requirement of the award.
The timeframe is very short; all nominations must be received by noon, May 2, 2008. Please
include all documentation including the nomination form to:
Attn: Marti Samsel
Sparrow Health System
Fax# (517) 364-3817
Or via email: marti.samsel@sparrow.org
Sincerely,
Marti A. Samsel
Past President, MCSHCA
Michigan Chapter – Society of Healthcare
Consumer Advocacy of the American
Hospital Association (MCSHCA)