ML Block Award Nomination 2019
The Dr. Martin Block award is given annually to an individual who has made a significant impact in the lives of America’s seniors through clinical leadership, policy vision or through superior example of RISE’s mission to promote continuous improvement in the health care system
1) Nominee must work within the clinical field as an MD, NP, RN, PA, DO or otherwise clinically credentialed
2) Nominee can work for a Healthplan, Accountable Care Organization or Vendor/Supplier to the healthcare marketplace
3) Nominee must have fulfilled one of the following criteria:
a. Contributed to significant process improvement in the care of seniors
b. Dedicated more than 10 years to exemplary work in this industry
4) Be nominated and presented to the Martin L Block Award nominating committee Forms must be completely filled out with necessary documentation

Nominee Name *
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Nominee Title *
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Nominee Company *
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Nominee Email *
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Nominee Phone number
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Nominators' Name, Company, and Email *
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Reasons for Nomination (Please refer to the nomination criteria. Limit: 1,000 words)
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