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  • TMP - 25160-Surat Pernyataan Komitmen Pelayanan-1787530621

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    Tmp_25160-Surat Pernyataan Komitmen Pelayanan-1787530621

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    83 views1 page

    TMP - 25160-Surat Pernyataan Komitmen Pelayanan-1787530621

    Uploaded by

    landong
    Bpjs 4

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    SURAT PERNYATAAN KOMITMEN PELAYANAN FKTP

    Saya yang bertandatangan dibawah ini:

    Nama : ..............................................................

    Jabatan : ..............................................................

    Mewakili FKTP.......................................... menyatakan komitmen sebagai berikut:

    1. Akan melayani peserta Jaminan Kesehatan Nasional sesuai ketentuan tanpa iur biaya
    2. Siap melaksanakan penilaian FKTP melalui Penilaian Kapitasi berbasis Komitmen Pelayanan
    3. Menyediakan PIC FKTP untuk dapat dihubungi terkait pelayanan informasi FKTP dan keluhan
    di FKTP yaitu:

    Nama : ...............................................................

    No Hp : ...............................................................

    4. Memasang surat pernyataan komitmen Pelayanan FKTP di FKTP agar terbaca oleh peserta.

    Demikian pernyataan komitmen pelayanan ini dibuat tanpa ada paksaan dari pihak manapun.

    Bogor, 2017

    Materai 6000 & Stempel FKTP

    (Nama lengkap)................................

    Jabatan

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