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  • HYDRA Feedback Form - Medical Facility

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    Ubaidullah Khan
    14 views1 page
    This document is a feedback form that collects information about a business issue, including the business entity and region involved, contact details for the person providing feedback, location and date of the incident, a summary of the feedback, acknowledgment of the feedback, and an action plan for addressing the issue. The form requests information like division, site type, city, date and how the feedback was received, and requires selecting items from dropdown menus or entering text for fields such as names and descriptions.

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    This document is a feedback form that collects information about a business issue, including the business entity and region involved, contact details for the person providing feedback, location and date of the incident, a summary of the feedback, acknowledgment of the feedback, and an action plan for addressing the issue. The form requests information like division, site type, city, date and how the feedback was received, and requires selecting items from dropdown menus or entering text for fields such as names and descriptions.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    14 views1 page

    HYDRA Feedback Form - Medical Facility

    Uploaded by

    Ubaidullah Khan
    This document is a feedback form that collects information about a business issue, including the business entity and region involved, contact details for the person providing feedback, location and date of the incident, a summary of the feedback, acknowledgment of the feedback, and an action plan for addressing the issue. The form requests information like division, site type, city, date and how the feedback was received, and requires selecting items from dropdown menus or entering text for fields such as names and descriptions.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 1

    Business Ownership (Which business has responsibility for managing the issue)

    Business Entity Choose an item. Region Choose an item.


    Admin Territory/Country Click here to enter text.      Site Type Choose an item.
    City/Site Click here to enter text.

    Division/Function Choose an item.


    Reporter Click here to enter text.

    Feedback Date

    Date of feedback Click here to enter a date.


    Who provided feedback Click here to enter text.     
    How was the feedback Click here to enter text.     
    received
    Click here to enter text.     

    Feedback Contact Person:

    Name Click here to enter text.     


    Phone Click here to enter text.     
    Email Click here to enter text.     
    Other Click here to enter text.     

    Feedback Details:

    Incident City Click here to enter text.     

    Incident Date Click here to enter a date.


    Feedback Summary

    Acknowledgement sent Click here to enter text.     


    by
    Date Acknowledgment Click here to enter text.     
    sent

    Action Plan:

    Response Summary Click here to enter text.     


    Reviewed by Click here to enter text.     
    Reason for feedback Choose an item.

    Contributing factors Choose an item.


    Date Acknowledgment Click here to enter a date.
    sent

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