FORMULIR PENYELESAIAN KOMPLAIN.docx

FORMULIR PENYELESAIAN KOMPLAIN, KELUHAN, KONFLIK ATAU PERBEDAAN PENDAPAT

 Nama pasien/keluarga

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Tanggal lahir

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Tanggal/Jam Komplain

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Ruangan/bagian

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URAIAN MASALAH : ........................................... ................................................................. ............................................ ............................................ .............................................. ......................................... ................. ........................................... ................................................................. ............................................ ............................................. ............................................. ........................................ .................. ........................................... ................................................................. ............................................ ............................................ .............................................. ......................................... ................. ........................................... .................................................................. ............................................. ............................................ ............................................ ........................................ .................. Penerima komplain

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TINDAKAN PENYELESAIAN KOMPLAIN ........................................... ................................................................. ............................................. ............................................. ............................................ ........................................ .................. ........................................... ................................................................. ............................................ ............................................ .............................................. ......................................... ................. ............................................ .................................................................. ............................................ ............................................ ............................................ ........................................ .................. ........................................... ................................................................. ............................................. ............................................. ............................................ ........................................ .................. ........................................... ................................................................. ............................................ ............................................ .............................................. ......................................... ................. ........................................... ................................................................. ............................................ ............................................. ............................................. ........................................ .................. Yang Menyelesaikan

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