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    Form. Komplain (Saran)

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    Mutiara Indah
    This document contains a complaint form and complaint resolution form for Rumah Sakit Umum Karya Husada hospital in Perdagangan, Simalungun Regency, North Sumatra. The complaint form requests the complainant's name, gender, occupation, address, phone number and details of their complaint or experience at the hospital. The complaint resolution form is used to document the date the complaint was resolved, the solution, and signatures from the complainant and the person who resolved it.

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    Form. Komplain (Saran)

    Uploaded by

    Mutiara Indah
    16 views2 pages
    This document contains a complaint form and complaint resolution form for Rumah Sakit Umum Karya Husada hospital in Perdagangan, Simalungun Regency, North Sumatra. The complaint form requests the complainant's name, gender, occupation, address, phone number and details of their complaint or experience at the hospital. The complaint resolution form is used to document the date the complaint was resolved, the solution, and signatures from the complainant and the person who resolved it.

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    kliu

    Original Title

    3. FORM. KOMPLAIN (SARAN)

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    This document contains a complaint form and complaint resolution form for Rumah Sakit Umum Karya Husada hospital in Perdagangan, Simalungun Regency, North Sumatra. The complaint form requests the complainant's name, gender, occupation, address, phone number and details of their complaint or experience at the hospital. The complaint resolution form is used to document the date the complaint was resolved, the solution, and signatures from the complainant and the person who resolved it.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    16 views2 pages

    Form. Komplain (Saran)

    Uploaded by

    Mutiara Indah
    This document contains a complaint form and complaint resolution form for Rumah Sakit Umum Karya Husada hospital in Perdagangan, Simalungun Regency, North Sumatra. The complaint form requests the complainant's name, gender, occupation, address, phone number and details of their complaint or experience at the hospital. The complaint resolution form is used to document the date the complaint was resolved, the solution, and signatures from the complainant and the person who resolved it.

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    of 2

    RUMAH SAKIT UMUM

    KARYA HUSADA

    Jln. Merdeka No. 12-18 Perdagangan 21184 Kec. Bandar - Kabupaten Simalungun
    Telp. + (0622) 697025 Sumatera Utara

    FORMULIR KOMPLAIN / SARAN

    Kepada Yth.
    Direktur Rumah Sakit Umum Karya Husada
    di
    Tempat

    Yang bertanda tangan di bawah ini :

    Nama : ………………………………………………………………
    Jenis Kelamin : ………………………………………………………….......
    Pekerjaan : ………………………………………………………...........
    Alamat : ………………………………………………………...........
    No. Telp / HP : ……………………………………………………………...

    Bersama ini disampaikan saran / keluhan kami mengenai pelayanan Rumah Sakit Karya Husada,
    tentang hal-hal yang dialami oleh kami sendiri/ keluarga dari pasien :

    Nama : …………………………………………
    Dirawat / berobat di Unit Rawat Jalan : …………………………………….......
    Mengenai / Hal : ………………………………………...
    Kronologis keluhan
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………
    ...…………………………………………………………………………………………………....
    ………………………………………………………………………………………………………

    Pertanyaan :
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………

    Saran / Harapan :
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………

    Perdagangan , ……………...............
    Hormat Kami,

    ( ........................................... )
     Rahasia Jabatan dipegang penuh
    RUMAH SAKIT UMUM
    KARYA HUSADA

    Jln. Merdeka No. 12-18 Perdagangan 21184 Kec. Bandar - Kabupaten Simalungun
    Telp. + (0622) 697025 Sumatera Utara

    PENYELESAIAN KOMPLAIN

    Tanggal Penyelesaian : ……………………………………………


    Solusi :
    ……………………………………………………………………….
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………
    ………………………………………………………………………………………………………

    Pihak Komplain, Diselesaikan Oleh,

    ( ……………………….. ) ( ……………………….. )

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