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KELUHAN PENGGUNA PELAYANAN

PUSKESMAS RAWAT INAP JUNGKAT TAHUN 2017

NAMA RESPONDEN : _______________________ NO. RESPONDEN :


TANGGAL :

1. APA KELUHAN ANDA DALAM PELAYANAN PUSKESMAS KAMI?


___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

2. APA SARAN ANDA KEPADA KAMI


___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

KELUHAN PENGGUNA PELAYANAN


PUSKESMAS RAWAT INAP JUNGKAT TAHUN 2017

NAMA RESPONDEN : _______________________ NO. RESPONDEN :


TANGGAL :

1. APA KELUHAN ANDA DALAM PELAYANAN PUSKESMAS KAMI?


___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

2. APA SARAN ANDA KEPADA KAMI


___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

KELUHAN PENGGUNA PELAYANAN


PUSKESMAS RAWAT INAP JUNGKAT TAHUN 2017

NAMA RESPONDEN : _______________________ NO. RESPONDEN :


TANGGAL :

1. APA KELUHAN ANDA DALAM PELAYANAN PUSKESMAS KAMI?


___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

2. APA SARAN ANDA KEPADA KAMI


___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

KELUHAN PENGGUNA PELAYANAN


PUSKESMAS RAWAT INAP JUNGKAT TAHUN 2017

NAMA RESPONDEN : _______________________ NO. RESPONDEN :


TANGGAL :

1. APA KELUHAN ANDA DALAM PELAYANAN PUSKESMAS KAMI?


___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

2. APA SARAN ANDA KEPADA KAMI


___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

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