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    April 5, 2019
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COMMUNIT COPPER QUEEN COMMUNITY HOSPITAL The 2019 Jane Delano Nursing Award Recognizing an Extraordinary Nurse H OUNDED Official Nomination Form Jane Delano was a Nominee Information remarkable nurse who I served in World War! Name: and was committed toCOCHfacility where they work (check onel the American Red Cross. oprValley Home Health Most importantly, she served the citizens of Bisbee in the late 1890s treating typhoid patients. She was committed to providing I OCOCH Bisbee COCH Douglas RHC or ED , CQCH Palominas Nursing Category of Nominee (check one): CQCH RHC Nurse Hospital Nurse Emergency Department Nurse health education and social services to rural communities, and she developed innovative nursing procedures for patients. I D Surgical Nurse Briefly explain why you believe this nurse deserves this award More than 100 years later, Jane's actions are reflected in the nurses I and care they provide at Copper Queen Community Hospital (COCH). We would like to celebrate and honor our nurses who give I exemplary care and continue the Delano tradition of providing health education and social services to our rural communities, We I will do so by providing a $2,500 award or scholarship to aurntlyI employed nurse at COCH. To be nominated, a nurse must meet the following criteria: IYour Information I Name: .Have a Registered Nurse degree or higher .Be currently employed at any CQCH location .Have a good attendance or reliability record Phone Number: Have a good safety record and low medication deviation Email Address: rate I May we use your comments: Yes No .Be active in the hospital and in the community .Demonstrate patient advocacy You can drop off or mail your nomination to: Have a desire to grow professionally I CopperQueen Community Hospital, 101 Cole Avenue, Bisbee, AZ 85603 Nomination forms also are available on our The deadline for nomination forms is Friday, May 3, 2019 and we encourage the community to nominate a nurse they believe deserves this recognition and award. The Award will be presented during our Nurses Week celebration in May 2019. website at www.cqch.org and on CommunityHospital Deadline is Friday, May 3. 2019 I Facebook: https//www.fa