Outstanding Physician Award Nomination Form

THE OUTSTANDING PHYSICIAN AWARD - 2022

PRESENTED ANNUALLY IN MARCH

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The Outstanding Physician Award honors physicians who have demonstrated distinguished leadership in organized medicine, community volunteerism, political and governmental activities, clinical excellence, and educational activities; particularly with medical students.

PREVIOUS RECIPIENTS

Dr. Thomas Hicks 2006 Dr. Terry McCoy 2007 Dr. Larry Deeb 2008 Dr. Ray Bellamy 2009 Dr. Gary Winchester 2010 Dr. Charles Moore 2011 Dr. Charles Williams 2012 Dr. Dean Watson 2013 Dr. Alma Littles 2014 Dr. Armand Cognetta 2015 Dr. Michael Forsthoefel 2016 Dr. Wayne Batchelor 2017 Dr. John Mahoney 2018 Dr. John Katopodis 2019 Dr. David Saint 2020/2021

NOMINATION FORM

NOMINEE’S NAME:

NOMINEE’S SPECIALTY AND PLACE OF PRACTICE:

HOW LONG HAS NOMINEE BEEN IN MEDICAL PRACTICE?

Please describe in 200 words or less how your nominee exemplifies leadership in medicine and in the community, as described above. This is required. Please be specific.

BLANK NOMINATIONS WILL NOT BE CONSIDERED. YOUR SUBMISSION MAY BE ATTACHED TO THIS FORM.

Nominator’s Name:

Telephone:

E-mail:

PLEASE SUBMIT YOUR NOMINATION TO THE CMS OFFICE (BY MAIL – 1204 MICCOSUKEE ROAD, TALLAHASSEE, FL 32308, OR BY E-MAIL – SBOYLE@CAPMED.ORG) BEFORE JANUARY 17, 2022.