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  • Form Penyelesaian Komplain

    Diunggah oleh

    Vinandita Nabilla Karina
    250 tayangan2 halaman

    Judul Asli

    FORM PENYELESAIAN KOMPLAIN.docx

    Hak Cipta

    © © All Rights Reserved

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    Unduh sebagai DOCX, PDF, TXT atau baca online dari Scribd
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    250 tayangan2 halaman

    Form Penyelesaian Komplain

    Diunggah oleh

    Vinandita Nabilla Karina

    Hak Cipta:

    © All Rights Reserved
    Unduh sebagai DOCX, PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    dari 2

    KOP

    FORMULIR PENYELESAIAN KOMPLAIN, KELUHAN,

    KONFLIK ATAU PERBEDAAN PENDAPAT

    Nama Pasien/Keluarga : No :...........................

    Tanggal Lahir : Masalah : Baru

    Tanggal/Jam Komplain : Lama

    Ruangan/Bagian :

    URAIAN MASALAH :

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    Penerima Komplain

    (.............................)

    TINDAKAN PENYELESAIAN SAAT KEJADIAN :

    ..........................................................................................................................................................................
    ..........................................................................................................................................................................
    ..........................................................................................................................................................................
    ..........................................................................................................................................................................
    ..........................................................................................................................................................................
    ..........................................................................................................................................................................
    ..........................................................................................................................................................................
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    Yang Menyelesaikan

    (................................)

    EVALUASI TINDAK LANJUT :

    Tidak perlu tindak lanjut

    Perlu tindak lanjut dengan Correction Action Request

    Evaluasi oleh

    (...............................)

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