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Feedback CAPA
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Month of Feedback Received *
Feedback Checked by staff of *
IP/OP
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Details of the  poor feedback ( UHID/Phone/Details) *
Details of Patient Contact *
Describe here,when & how did you contact to patient,  what was the reply by patient, ask the patient will you suggest the hospital to other, what was the reply any RCA found etc)
Do you want to escalate the feedback to MS/AC Committee *
Describe here,when & how did you contact to patient,  what was the reply by patient, ask the patient will you suggest the hospital to other, what was the reply any RCA found etc)
Done by Employee Name & ID *
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