Formulir Keluhan Pasien 5g3aj
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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 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? :
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