Promise In Action

1
Hi! Let's begin with your name.* This field is required.
First Name
Last Name
2
Hi {hiLets:first}, are you recognizing an individual caregiver or a team of caregivers today?* This field is required.
Individual CaregiverTeam of Caregivers
3
What is the name of the Caregiver you are recognizing?* This field is required.Please ensure accurate spelling of the caregiver's name. Incorrect spelling could prevent the caregiver from receiving this nomination or from being counted towards their milestone pin count.
First Name
Last Name
4
Oh, we love {whatIs:first}! To avoid recognizing the wrong {whatIs}, what is {whatIs:first}'s email address? (Optional but hugely helpful)You’d be amazed how often names change around here
example@example.com
5
Great! Where is {whatIs}'s office or department located?
Humboldt County
Napa County
Sonoma, Mendocino or Lake County
All over, they are Regional
6
These counties are some of the most beautiful. Now select {whatIs}'s department name or office locationIf you don't know the department or office, you can skip this question
Administration
After Hours Care - Montgomery
After Hours Care - Sebastopol
After Hours Care - Washington
After Hours Care - Windsor
Bethards Family Practice
Brookwood Ophthalmology
Chargeback Admin
Clinical Trials
Coding
College Pulmonology/Sleep Medicine
Dora Radiation Oncology
Doyle Park Cardiology
Doyle Park Family Medicine
Doyle Park Gastroenterology
Doyle Park Neurosurgery
Doyle Park OB/GYN
Doyle Park Otolaryngology (ENT)
Doyle Park Palliative Care
Doyle Park Pediatrics
Doyle Park Urgent Care
Doyle Park Urology
Facilities/CBRE
Float Pool
Health Equity
Health Information Management
Hill Oncology
Hospital Based Services
Human Resources
IS - Information Services
IT - Information Technology
IT Training
Lynch Creek Cardiology
Lynch Creek Chemotherapy
Lynch Creek General Surgery
Lynch Creek Lab
Lynch Creek Nephrology
Lynch Creek Oncology
Lynch Creek Podiatry
Lynch Creek Radiation Oncology
Lynch Creek Radiation Therapy
March Pediatrics
Montgomery Endocrinology
Montgomery Gastroenterology
Montgomery General Surgery
Montgomery Orthopedics (Sports Med)
Montgomery Primary Care
Montgomery Psychiatry
Montgomery Rheumatology
Montgomery Vascular Surgery
Palliative Care
Patient Access Center
Patient Experience
Physical Medicine and Rehab
Physician
Physician Relations
Professional Drive OB/GYN
Professional Drive Pediatrics
Professional Orthopedics
Project Management
Provider Relations
Quality Improvement
Referral Department - NorCal
Rohnert Park Internal Medicine
Round Barn Cancer Center - All Departments
Round Barn Chemotherapy
Round Barn Oncology
Round Barn Pharmacy
Round Barn Radiation Lab
Round Barn Radiation Oncology
Round Barn Radiation Therapy
Sebastopol Family Medicine
Sonoma Ave Neurology
Sonoma Ave Pediatrics & Child Development
Sotoyome Breast Surgery
Sotoyome Orthopedics
Sotoyome Primary Care Oncology
Sotoyome Vascular Surgery
SRMH Trauma Surgery
Ukiah Cardiology
Ukiah Diagnostics
Washington Primary Care
Windsor Family Practice
7
I just love Napa! Now select {whatIs}'s department name or office locationIf you don't know the department or office, you can skip this question
Administration
Facilities/CBRE
Float Pool
Health Equity
Health Information Management
Hospital Based Services
Human Resources
Patient Access Center
Palliative Care
Physician
Urgent Care
Referral Department - NorCal
Trancas Cardiac Rehab
Trancas Family Practice
Trancas Gastroenterology
Trancas Internal Medicine
Trancas Medical Oncology
Trancas Neurology
Trancas OB
Trancas Otolaryngology
Trancas Urology
Villa Lane Cardiology
Villa Lane Gen Surgery
8
Humboldt is so majestic! Now select {whatIs}'s department name or office locationIf you don't know the department or office, you can skip this question
23rd Street Cardiology
23rd Street Lab
Administration
Buhne Dermatology
Buhne Otolaryngology
Buhne Plastics
Facilities/CBRE
Float Pool
Harris Cardiology
Harris Neurosurgery
Harris Orthopedics
Harris Pain Management
Harris Physical Medicine and Rehabilitation
Harris Pulmonology
Harrison Allergy
Harrison Family Practice
Harrison Gastroenterology
Harrison General Surgery
Harrison Infectious Disease
Harrison Internal Medicine
Harrison Rheumatology
Health Equity
Health Information Management
Hospital Based Services
IT - Information Technology
IT Training
Juliette Oncology
Oneil Neurology
Patient Access Center
Palliative Care
Physician
Referral Department - NorCal
Renfrew Urology
Renner General Surgery
Renner ENT
Walford OB-GYN
Walford Pediatrics
9
Wow, they must really rack up the miles. Now select {whatIs}'s department name or office locationIf you don't know the department or office, you can skip this question
Administration
Clinical Operations
Facilities/CBRE
Health Equity
Health Information Management
Hospital Based Services
Human Resources
IT / IS
Marketing and Communication
Mission Integration
Palliative Care
Patient Access Center
Patient Experience
Project Management
Provider Recruitment
Quality Improvement
Referral Department - NorCal
10
Would you like to share the names of the caregivers for the team you are recognizing?* This field is required.If the "NO" option is selected, this Team Recognition will be forwarded to the office site leader(s) for distribution to the team.
YESNO
11
Who are the caregivers you are recognizing as part of this team?Please ensure accurate spelling of the caregiver's name. Incorrect spelling could prevent the caregiver from receiving this nomination or from being counted towards their milestone pin count.
12
Great! Where is this office or department located?* This field is required.
Humboldt County
Napa County
Sonoma, Mendocino or Lake County
All over, they are Regional
13
These counties are some of the most beautiful. Who is the team you are recognizing today?* This field is required.
Administration
After Hours Care - Montgomery
After Hours Care - Sebastopol
After Hours Care - Washington
After Hours Care - Windsor
Bethards Family Practice
Brookwood Ophthalmology
Chargeback Admin
Clinical Trials
Coding
College Pulmonology/Sleep Medicine
Dora Radiation Oncology
Doyle Park Cardiology
Doyle Park Family Medicine
Doyle Park Gastroenterology
Doyle Park Neurosurgery
Doyle Park OB/GYN
Doyle Park Otolaryngology (ENT)
Doyle Park Palliative Care
Doyle Park Pediatrics
Doyle Park Urgent Care
Doyle Park Urology
Facilities/CBRE
Float Pool
Foundation
Health Equity
Health Information Management
Hill Oncology
Hospital Based Services
Human Resources
IS - Information Services
IT - Information Technology
IT Training
Lynch Creek Cardiology
Lynch Creek Chemotherapy
Lynch Creek General Surgery
Lynch Creek Lab
Lynch Creek Nephrology
Lynch Creek Oncology
Lynch Creek Podiatry
Lynch Creek Radiation Oncology
Lynch Creek Radiation Therapy
March Pediatrics
Montgomery Endocrinology
Montgomery Gastroenterology
Montgomery General Surgery
Montgomery Orthopedics (Sports Med)
Montgomery Primary Care
Montgomery Psychiatry
Montgomery Rheumatology
Montgomery Vascular Surgery
Palliative Care
Patient Access Center
Patient Experience
Physical Medicine and Rehab
Physician
Physician Relations
Professional Drive OB/GYN
Professional Drive Pediatrics
Professional Orthopedics
Project Management
Provider Relations
Quality Improvement
Referral Department - NorCal
Rohnert Park Internal Medicine
Round Barn Cancer Center - All Departments
Round Barn Chemotherapy
Round Barn Oncology
Round Barn Pharmacy
Round Barn Radiation Lab
Round Barn Radiation Oncology
Round Barn Radiation Therapy
Sebastopol Family Medicine
Sonoma Ave Neurology
Sonoma Ave Pediatrics & Child Development
Sotoyome Breast Surgery
Sotoyome Orthopedics
Sotoyome Primary Care Oncology
SRMH Trauma Surgery
SRMH Urgent Care Clinic
Ukiah Cardiology
Ukiah Diagnostics
Washington Primary Care
Windsor Family Practice
14
I just love Napa! Who is the team you are recognizing today?* This field is required.
Administration
Facilities/CBRE
Float Pool
Health Equity
Health Information Management
Hospital Based Services
Human Resources
Patient Access Center
Palliative Care
Physician
Referral Department - NorCal
Trancas Cardiac Rehab
Trancas Family Practice
Trancas Gastroenterology
Trancas Internal Medicine
Trancas Medical Oncology
Trancas Neurology
Trancas OB
Trancas Otolaryngology
Trancas Urology
Urgent Care
Villa Lane Cardiology
Villa Lane Gen Surgery
15
Humboldt is so majestic! Who is the team you are recognizing today?* This field is required.
23rd Street Cardiology
23rd Street Lab
Administration
Buhne Dermatology
Buhne Otolaryngology
Buhne Plastics
Facilities/CBRE
Float Pool
Harris Cardiology
Harris Neurosurgery
Harris Orthopedics
Harris Pain Management
Harris Physical Medicine and Rehabilitation
Harris Pulmonology
Harrison Allergy
Harrison Family Practice
Harrison Gastroenterology
Harrison General Surgery
Harrison Infectious Disease
Harrison Internal Medicine
Harrison Rheumatology
Health Equity
Health Information Management
Hospital Based Services
IT - Information Technology
IT Training
Juliette Oncology
Oneil Neurology
Patient Access Center
Palliative Care
Physician
Referral Department - NorCal
Renfrew Urology
Renner General Surgery
Renner ENT
Walford OB-GYN
Walford Pediatrics
16
Wow, they must really rack up the miles. Who is the team you are recognizing today?* This field is required.
Administration
Clinical Operations
Facilities/CBRE
Health Equity
Health Information Management
Hospital Based Services
Human Resources
IT / IS
Marketing and Communication
Mission Integration
Palliative Care
Patient Access Center
Patient Experience
Project Management
Provider Recruitment
Quality Improvement
Referral Department - NorCal
17
Describe how this caregiver or team demonstrated Our Promise of "Know me, care for me, ease my way." Please share specific details to illustrate the impact these behaviors and actions made.* This field is required.Start with the SITUATION, provide the ACTIONS taken and share the RESULTS that occurred.
18
Which Own It G.R.E.A.T. declaration best embodies the recognition of this caregiver or team?* This field is required.
GREET: I own how i greet and welcome you
RESPECT: I own how i show you respect
ENGAGE: I own how i engage you and discover your needs
ASSIST: I own how i assist you and personalize my actions for you
TRANSITION: I own how i assist you and transition your continuum of care and service
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Which Value do you believe best fits this recognition?* This field is required.
20
Which part of Our Promise do you think best fits this recognition?
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(Retired)Which Value do you believe best fits this recognition?
We reach out to those in need and offer comfort as Jesus did. We nurture the spiritual, emotional and physical well-being of one another and those we serve. Through our healing presence, we accompany those who suffer.
We value, encourage and celebrate the gifts in one another. We respect the inherent dignity and worth of every individual. We recognize each interaction as a sacred encounter.
We foster a culture that promotes unity and reconciliation. We strive to care wisely for our people, our resources and our earth. We stand in solidarity with the most vulnerable, working to remove the causes of oppression and promoting justice for all.
We set the highest standards for ourselves and our ministries. Through transformation and innovation, we strive to improve the health and quality of life in our communities. We commit to compassionate, safe and reliable practices for the care of all.
We hold ourselves accountable to do the right things for the right reasons. We speak the truth with courage and respect. We pursue authenticity with humility and simplicity.
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{hiLets}, what is your email so we can send you this nomination for {whatIs}?
example@example.com
23
Would you like this nomination to be considered for a Values In Action nomination?If yes, you may be contacted when the VIA process begins so we can prepare a formal submission.
YESNO
24
Total Nominations Submitted
Should be Empty: