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<div class=\'form-group\'><label for=\'FormField2_36ec02d1-26ff-436a-8c7d-b3a161e88e36\' class=\'control-label  \'>Name of the nurse you are nominating:<span class=\'fb-required\'>*</span></label><div>\
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</div></div><p>Our DAISY Award honorees demonstrate Henry Mayo&rsquo;s WE CARE principles. Our RNs and LVNs also demonstrate clinical expertise and compassionate care. They are recognized as role models in our nursing community. We will recognize one of our nurses with this special honor each month. Each DAISY Award Honoree will be recognized at a ceremony on his/her unit.</p><p><strong>WE CARE Principles:<br></strong><strong>W</strong>elcome: make our patients/visitors feel welcome to our hospital/unit<br><strong>E</strong>xplain: what we are doing/what to expect<br><strong>C</strong>ompassion: show to all in every interaction<br><strong>A</strong>nswer: questions, address concerns<br><strong>R</strong>eassure: we are here for our patients<br><strong>E</strong>xpress: our appreciation for allowing us to care for our patients</p><div class=\'form-group\'><label for=\'FormField5_36ec02d1-26ff-436a-8c7d-b3a161e88e36\' class=\'control-label  \'>I would like to thank my nurse and share my story of why this nurse is so special:<span class=\'fb-required\'>*</span></label><div>\
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</div></div><div class=\'form-group\'><label  class=\'control-label  \'>Please contact me if my nurse is chosen as a DAISY Honoree so that I may attend the celebration if available.<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'flow\'><input type=\'radio\' value=\'Yes\' required data-msg-required=\'Please contact me if my nurse is chosen as a DAISY Honoree so that I may attend the celebration if available. is required.\' name=\'checkbox10\' id=\'FormField10_36ec02d1-26ff-436a-8c7d-b3a161e88e36_1\' class=\'right\' data-export-label=\'Contact_Me\' ><label for=\'FormField10_36ec02d1-26ff-436a-8c7d-b3a161e88e36_1\'>Yes</label></div><div class=\'flow\'><input type=\'radio\' value=\'No\' required data-msg-required=\'Please contact me if my nurse is chosen as a DAISY Honoree so that I may attend the celebration if available. is required.\' name=\'checkbox10\' id=\'FormField10_36ec02d1-26ff-436a-8c7d-b3a161e88e36_2\' class=\'right\' data-export-label=\'Contact_Me\' ><label for=\'FormField10_36ec02d1-26ff-436a-8c7d-b3a161e88e36_2\'>No</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>I am (please check one):<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'flow\'><input type=\'radio\' value=\'RN\' required data-msg-required=\'I am (please check one): is required.\' name=\'checkbox11\' id=\'FormField11_36ec02d1-26ff-436a-8c7d-b3a161e88e36_1\' class=\'right\' data-export-label=\'I_Am\' ><label for=\'FormField11_36ec02d1-26ff-436a-8c7d-b3a161e88e36_1\'>RN</label></div><div class=\'flow\'><input type=\'radio\' value=\'MD\' required data-msg-required=\'I am (please check one): is required.\' name=\'checkbox11\' id=\'FormField11_36ec02d1-26ff-436a-8c7d-b3a161e88e36_2\' class=\'right\' data-export-label=\'I_Am\' ><label for=\'FormField11_36ec02d1-26ff-436a-8c7d-b3a161e88e36_2\'>MD</label></div><div class=\'flow\'><input type=\'radio\' value=\'Patient\' required data-msg-required=\'I am (please check one): is required.\' name=\'checkbox11\' id=\'FormField11_36ec02d1-26ff-436a-8c7d-b3a161e88e36_3\' class=\'right\' data-export-label=\'I_Am\' ><label for=\'FormField11_36ec02d1-26ff-436a-8c7d-b3a161e88e36_3\'>Patient</label></div><div class=\'flow\'><input type=\'radio\' value=\'Family/Visitor\' required data-msg-required=\'I am (please check one): is required.\' name=\'checkbox11\' id=\'FormField11_36ec02d1-26ff-436a-8c7d-b3a161e88e36_4\' class=\'right\' data-export-label=\'I_Am\' ><label for=\'FormField11_36ec02d1-26ff-436a-8c7d-b3a161e88e36_4\'>Family/Visitor</label></div><div class=\'flow\'><input type=\'radio\' value=\'Staff\' required data-msg-required=\'I am (please check one): is required.\' name=\'checkbox11\' id=\'FormField11_36ec02d1-26ff-436a-8c7d-b3a161e88e36_5\' class=\'right\' data-export-label=\'I_Am\' ><label for=\'FormField11_36ec02d1-26ff-436a-8c7d-b3a161e88e36_5\'>Staff</label></div><div class=\'flow\'><input type=\'radio\' value=\'Volunteer\' required data-msg-required=\'I am (please check one): is required.\' name=\'checkbox11\' id=\'FormField11_36ec02d1-26ff-436a-8c7d-b3a161e88e36_6\' class=\'right\' data-export-label=\'I_Am\' ><label for=\'FormField11_36ec02d1-26ff-436a-8c7d-b3a161e88e36_6\'>Volunteer</label></div></fieldset></div></div></div><div class=\'form-group\'><label for=\'FormField13_36ec02d1-26ff-436a-8c7d-b3a161e88e36\' class=\'control-label  \'>Date of Nomination:<span class=\'fb-required\'>*</span></label><div><div class=\'clearfix\'><input type=\'text\' name=\'FormField13_36ec02d1-26ff-436a-8c7d-b3a161e88e36\' id=\'FormField13_36ec02d1-26ff-436a-8c7d-b3a161e88e36\' class=\'form-control input-medium isDatePicker\' required data-msg-required=\'Date of Nomination: is required.\' data-format=\'mm/dd/yy\' data-export-label=\'Date_of_Nomination\'  data-rule-dateFormat=\'MM/DD/YYYY\' style=\'float: left;\' /></div></div></div>\
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