Form Komplain Pasien Keluarga.docx

FORMULIR KOMPLAIN /SARAN

Yth kepala Rumah Sakit BLUD RSUD Nabire Yang bertanda tangan di tangan ini Nama

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Jenis kelamin :..................................................................................... Pekerjaan

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Alamat

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Bersama ini disampaikan saran /keluhan kami mengenai pelayanan Rumah Sakit BLUD RSUD Nabire tentang hal-hal yang dialami oleh kami Oleh kami sendiri /keluarga dari pasien : Nama

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Dirawat /berobat di poliklinik :........................................................... Mengenai /Hal :.................................................................................. Kronologi keluhan :.............................................................................. ........................................................................................................... ............................................................................................................. .......................................................................................................... Nabire ,................. Hormat kami

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