Health Organisation Award From

    Candidate Organisation Name *

    Candidate Contact Person Phone Number *

    Candidate Contact Person

    First Name

    Last Name

    Candidate Contact Person Email *

    Nominators Name *

    First Name

    Last Name

    Nominators Phone Number *

    Nominators Email *


    Street Address


    State / Province / Region

    Postal / Zip Code


    1) Describe how this organisation has achieved better healthcare outcomes through partnering with consumers, carers and/or the community. *

    2) Describe how the organisation demonstrates ongoing partnerships with consumers.

    3) Describe how the organisation sustains partnerships with consumers.

    4) Identify how the organisation monitors and evaluates their patient experience. What KPIs, targets or objectives are set to monitor outcomes? *

    5) Attach any letters of support from consumers that show evidence that the organisation values consumer participation.

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