Formulir Penyelesaian Komplain PMC
Formulir Penyelesaian Komplain PMC
RM :
PEKANBARU MEDICAL CENTER Nama :
Tgl Lahir :
Jl. Lembaga Pemasyarakatan No. 25 Gobah Pekanbaru Jenis Kelamin :
Telp. (0761) 848100, 859510 Fax. (0761) 85951
Nama pasien/keluarga :
Tanggal lahir :
Tanggal/Jam Komplain :
Ruangan/bagian :
URAIAN MASALAH :
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Penerima komplain
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Yang Menyelesaikan
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Rumah Sakit PMC No. RM :
PEKANBARU MEDICAL CENTER Nama :
Tgl Lahir :
Jl. Lembaga Pemasyarakatan No. 25 Gobah Pekanbaru Jenis Kelamin :
Telp. (0761) 848100, 859510 Fax. (0761) 85951
EVALUASI/TINDAK LANJUT: