Complaint Page-0001

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KY “Te Dram te |; — Z thacn fol V< NG MEDICARE AND CALCUTTA HOPE INFERTILITY CLINIC Format No. ; NG/FMI16 _ COMPLAINT/SUGGESTION FORM = = int /Suggestion: « W33 noe Nath Raw Name of the Compiai Address Oy ~ Rash Oehert Boome Vp lah Pedag == Seyescins |" asetesciqgg [emai Ragen nor oul @ gira! «Cron, | To Anfticient tl beg Coumbee ae Pre lene f> PARC ye oD ia, he Path once (ronmedtetabs bo ur | pate; VN Ua A wo tn tame — Patient's IDNo _ | VisitDate: — ‘Report Date: pr ED SPIT IYorfacrs |" Vafortasts Patient's Name: Sex: od Meant Raw - Me bis ys / wo Bo, Rarh Paneur hos Rol Radifores Referred Doctor; _ SSB Remarks: She Ts poor CAMS penttenen Paltenr, Se had te wath a long Ame tin bing. She pewwesk fo Mnewesse He num PY Counsemg. So TRH Shite Ppeeple te wih | hope te walk any lengen ‘Complaint Suggestion Reviewed By: bo» j>o Date: 16 L0% JA Koh ar, &, casera aw WRT a ST He Cointcarente fet) ascent og wferatetts are: = almy Dont jot Biighang “Road TAR FOR) 24) Y3z | curate =: ea: anion Rea There Mint? be tre aie beard .al- Reece fin aye r Jno ae: an tie ‘oh wie Bat: mre Roch oie: wha A: Svdsskna Roy tea am SHES: ita cera a: CAH S Sera: 6G: Woe has ne Complam he ie psweoded te anpenge oh Fie th play beara dev deuer- oferats cette ee Sto TR tte: ge }°2)24

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