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UMPAN BALIK KEGIATAN PUSKESMAS SEPANJANG TAHUN 2017

Judul Kegiatan :

Tanggal :

Nama Responden :

Dalam upaya meningkatkan Mutu dan Kualitas Pelayanan Puskesmas menjadi lebih baik, Kami
sangat mengharapkan Bapak/ Ibu berkenan memberikan kritik, saran serta harapan Anda kepada
Kami tentang kegiatan ini !

Kritik : ......................................................................................................................................................
..................................................................................................................................................

Saran : ......................................................................................................................................................
..................................................................................................................................................

Harapan : .................................................................................................................................................
......................................................................................................................................................

UMPAN BALIK KEGIATAN PUSKESMAS SEPANJANG TAHUN 2017


Judul Kegiatan :

Tanggal :

Nama Responden :

Dalam upaya meningkatkan Mutu dan Kualitas Pelayanan Puskesmas menjadi lebih baik, Kami
sangat mengharapkan Bapak/ Ibu berkenan memberikan kritik, saran serta harapan Anda kepada
Kami tentang kegiatan ini !

Kritik : ......................................................................................................................................................
..................................................................................................................................................

Saran : ......................................................................................................................................................
..................................................................................................................................................

Harapan : .....................................................................................................................................
....................................................................................................................................................
...............

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