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FORM KEPUASAN PASIEN

Bulan :

Unit / Ruangan :

Kepuasan Pasien

No.
Responden Nilai Unsur Pelayanan

U1 U2 U3 U4 U5 U6 U7 U8 U9

Rawa Bening,
Ketua Audit

Tri Rezeki, A. Md. Kep


Nip. 19810315 201409 2001

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