1. Nomination form
MEDICAL
EXCELLENCE
AWARD - 2014
th 30 NOVEMBER, 2014

2. Instructions For Submission of the Application For
“Medical Excellence Awards” 2014.
Nominations Closure
Last day for nominations – 30th September, 2014.
Nomination Criteria
The applicant should be individual doctor only. He / She must be a medical
practitioner registered under the MCI / State Medical Council.
Criteria to invite Nominees
The nominations could be by:
Invitation.
Self Nomination.
Evaluation criteria
Each Nomination will be evaluated under various categories shall be assessed by
the Medical Excellence Award Jury on below mentioned criterions:
vRelevance
vOriginality
vSustain ability
vEvidence of education work qualication
vContribution to society
vInternational honor
vEducation Research
vAwards Recognition
vWork Philosophy

3. Nominee Detail:
Doctor
Specialization
Ofcial name
Mailing address
Application Form
Ofcial Contact Point
Designate a person with a good understanding of the application, and the authority to answer
inquiries and arrange documents. If the ofcial contact point changes during the
application process, please inform immediately.
Name__________________________________ Designation : ______________________________
Phone___________________________________ Mobile : __________________________________
Fax____________________________ Email : _____________________________________________
No objection and ethic Statement
Applicant shall sign the nomination form and submit it along with a prole picture (Softcopy)
and self attested copies of certicates and awards (please don't send originals)
I understand that this application will be reviewed by members and ofcials of the MEA
If I am selected then my details will be published on various marketing collaterals.
I agree that I will host the site visit, facilitate an open and unbiased assessment.
State and attest that:
I have reviewed the information provided by me/my organization
in this award application details.
The details are true to my knowledge and neglects no material fact that I am legally
permitted to disclose and that affects my professional ethics and legal practices.
Signature of nominated doctor with Stamp
Medical Excellence Award
E-49, 2nd Floor, Sector-3, Noida | Phone : 0120-2540396 | 2540152
Website : www.medicalexcellenceawards.com | E-mail : info@medicalexcellenceawards.com

4. DOMAINS
1 Allergy
2 Anaesthesia
3 Andrology
4 Asthma
5 Audiology
6 Biochemistry
7 Cardio Thoracic and Vascular Surgery
8 Cardiology 9Chest Specialist
10 Dermatology
11 Diabetology
12 Endocrinology
13 Epidemiology / Community Medicine
14 Forensic Medicine
15 Gastroenterology
16 General Surgery
17 Genecs
18 Haematology
19 Immunology / Immunogenecs
20 Indian Medicine / General Prac