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KUESIONER SURVEY KEPUASAN MASYARAKAT UNIT PELAYANAN KESEHATAN KEMENTERIAN KESEHATAN
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Tanggal Survei
*
MM
/
DD
/
YYYY
Jam Survei
*
08.00 - 12.00 WIB
13.00 - 16.00 WIB
𝐈. 𝐏𝐑𝐎𝐅𝐈𝐋 𝐑𝐄𝐒𝐏𝐎𝐍𝐃𝐄𝐍
Nama (Inisial)
*
Your answer
Umur
*
Your answer
Jenis Kelamin
*
Laki-Laki
Perempuan
No Telepon (Jika Bersedia)
Your answer
Satuan Kerja (Diisi oleh pegawai Kemenkes)
*
Your answer
Pekerjaan
*
PNS
PPPK
PPNPN
Other:
1. Klinik Pratama (Jenis Layanan Yang Diterima)
Choose
Pendaftaran
Poli Umum
Poli Gigi dan Mulut
Kebidanan dan KIA
Layanan Vaksin
2. Klinik Utama (Jenis Layanan Yang Diterima)
Choose
Pendaftaran
Spesialis Konservasi Gigi
Spesialis Okupasi
Spesialis Paru
Spesialis Rehab Medik
Spesialis Jantung
Radiologi
Laboratorium
Farmasi
Fisioterapi
IGD
Layanan SWAB PCR/ANTIGEN
GIZI
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