Caregram test Caregram Old (using Sitefinity MD Staff API) Caregram form for public users to recognize a Caregiver Today, I Wish To Recognize a Caregiver Test FormEmployee, Team or Provider InformationDateHospital Or Medical Office(Required)HospitalMedical OfficeLocationSelect a location...Other LocationDepartmentSelect a location above to see a list of departments...Other DepartmentDate of Service MM slash DD slash YYYY Room Number/AreaPatient First and Last Name(Required)Employee, Team or Provider First NameEmployee, Team or Provider Last Name(If you do not know the first or last name of the employee, please type “Unknown” in the required fields).Submitter InformationYour Name(Required) First Last Phone Number(Required)I am a(Required)Select A TypePatientFamily MemberVisitorThe Action That I Feel Deserves Recognition(Required)Terms and Conditions(Required) Accept Terms and Conditions By checking this box you permit and authorize St. Elizabeth Healthcare to use any or all of the information above in current and future marketing materials. These materials may be copied and distributed by means of various media, including video presentations, television, news bulletins, mailouts, billboards or signs, brochures, placement on the St. Elizabeth Healthcare website, or newspapers. You understand that, although St. Elizabeth Healthcare will endeavor to use your submitted information in accordance with standards of good judgment, St. Elizabeth Healthcare cannot guarantee that any further dissemination of submitted information will be subject to similar supervision or control. Accordingly, you release St. Elizabeth Healthcare from any and all liability related to dissemination of your submitted information. Please note that we will not publicize or share your name, e-mail address, or phone number nor will we use them in any marketing materials. Please verify that you are not a robot before submitting the form. This field is hidden when viewing the formInternal Recipient St. Elizabeth Website Coordinator2024-12-12T12:03:46-05:00Thursday, December 12, 2024|Uncategorized| Share This Story, Choose Your Platform! FacebookXLinkedInEmail