FORMULIR KELUHAN PASIEN

March 25, 2017 | Author: heribertuz | Category: N/A

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Download FORMULIR KELUHAN PASIEN...

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No: __________

FORMULIR KELUHAN Grievance Form Nama/ Name : ______________________________

Diterima oleh/ Received by : ______________________

Alamat/ Address : __________________________ ___________________________ ___________Telp: ___________

Tanggal/ Date : ________________________________ Lokasi/ Location : ______________________________

Tandatangan/ Signature : ______________________

Tanggapan oleh/ Response due by : _______________

Tanggal/ Date : ______________________________

_____________________________________________

Uraian Keluhan/ Description of Grievance :

Apa yang diinginkan dari perusahaan untuk menyelesaikan masalah tersebut? / What is the proposed solution from company? :

FORMULIR KELUHAN PASIEN

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