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  • Informed Consent

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    Dion Ananta
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    This document is a request for informed consent from patients to participate in a study about the relationship between nursing care quality and patient satisfaction at a health center. It introduces the student researcher conducting the study for their university degree. It assures participants that their responses will remain confidential and asks them to sign agreeing to participate before leaving the health center.

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    This document is a request for informed consent from patients to participate in a study about the relationship between nursing care quality and patient satisfaction at a health center. It introduces the student researcher conducting the study for their university degree. It assures participants that their responses will remain confidential and asks them to sign agreeing to participate before leaving the health center.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    9 views1 page

    Informed Consent

    Uploaded by

    Dion Ananta
    This document is a request for informed consent from patients to participate in a study about the relationship between nursing care quality and patient satisfaction at a health center. It introduces the student researcher conducting the study for their university degree. It assures participants that their responses will remain confidential and asks them to sign agreeing to participate before leaving the health center.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 1

    INFORMED CONSENT

    PERSETUJUAN MENJADI RESPONDEN

    Selamat Pagi/Siang/Sore Perkenalkan nama Saya Dion mahasiswi S1


    Stikes Satria Bhakti Nganjuk, Saya bermaksud melakukan penelitian mengenai
    “HUBUNGAN MUTU PELAYANAN ASUHAN KEPERAWATAN DENGAN
    KEPUASAN PASIEN RAWAT INAP DI PUSKESMAS BALEREJO
    MADIUN”. Penelitian ini dilakukan sebagai tahap akhir dalam penyelesaian studi
    di Stikes Satria Bhakti Nganjuk. Saya berharap Bapak/Ibu/Sdr bersedia untuk
    menjadi responden dalam penelitian ini di mana akan dilakukan pengisian angket
    yang terkait dengan penelitian. Semua informasi yang Saudara berikan terjamin
    kerahasiaannya. Pengumpulan kembali kuesioner ini diharapkan paling lambat
    sebelum pasien/Bapak/Ibu/Sdr meninggalkan Puskesmas Balerejo.
    Setelah Ibu membaca maksud dan kegiatan penelitian di atas, maka saya
    mohon untuk mengisi nama dan tanda tangan dibawah ini. Saya setuju untuk ikut
    serta dalam penelitian ini.
    Nama : _________________________________________
    Tanda tangan : _________________________________________

    Terima kasih atas kesediaan Bapak/Ibu/Sdr untuk ikut serta di dalam penelitian
    ini.

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