Are you nominating yourself?:
YesNo

Current nominee contact details:

Contact name:

Name of organisation:

Phone:

Email:

Images received will be used for promotion of the Pen CS Awards by Pen CS.

Please upload the nominee(s) image:

Files cannot be larger than 5MB each.
Examples include photos of the nominee(s) practice team, their team at work or a photo of their practice.

Please upload the nominee(s) organisation's logo:

Files cannot be larger than 5MB each.

AWARD CATEGORY
‘Closing the Gap’ AwardQuality Improvement Initiative of the Year AwardData-driven Clinical Excellence AwardResearch in General Practice AwardData Quality AwardDigital Innovation AwardPatient-centred Care AwardCAT Plus Super User Award

Please follow the maximum word limit for each nomination question; dot point responses are encouraged. The achievements described in the nomination must have been completed within Australia and have taken place between July 2021 and June 2022.

For all Pen CS award category nominations, the same questions will apply. Please answer the following questions.

Question 1: How has the nominee positively impacted health outcomes within their local Australian community? Be sure to identify how a problem was resolved, any outcomes that resulted from this achievement and support your response with quantitative evidence and/or research. Max 300 words.

words. Please limit to 300 words or less Without Space.

Question 2: How has Pen CS software, such as CAT or Topbar, supported the nominee to achieve this outcome? Max 200 words.

words. Please limit to 200 words or less Without Space.

Question 3: How has the nominee demonstrated their value and contribution to the chosen award category? Max 100 words.

words. Please limit to 100 words or less Without Space.

I, the nominator declare that the information provided in this nomination is true and correct. I also understand that any wilful dishonesty will result in the nomination being rejected.

I, the nominator agree that I have read the terms and conditions here