Você está na página 1de 1

ANGKET HAMBATAN DALAM PELAYANAN KESEHATAN DI PUSKESMAS KELURAHAN JELAMBAR BARU

POLI :

1. Apakah anda pernah mengalami hambatan dalam pelayanan kesehatan pada poli anda?
Ya / Tidak
(*coret yang tidak perlu)
2. Hambatan apa yang pernah anda jumpai?
A. Hambatan dalam system / proses pelayanan
.........................................................................................................................................................................
.........................................................................................................................................................................
.........................................................................................................................................................................
B. Hambatan dari petugas
.........................................................................................................................................................................
.........................................................................................................................................................................
.........................................................................................................................................................................
C. Hambatan dari pasien
.........................................................................................................................................................................
.........................................................................................................................................................................
.........................................................................................................................................................................

ANGKET HAMBATAN DALAM PELAYANAN KESEHATAN DI PUSKESMAS KELURAHAN JELAMBAR BARU

POLI :

1. Apakah anda pernah mengalami hambatan dalam pelayanan kesehatan pada poli anda?
Ya / Tidak
(*coret yang tidak perlu)
2. Hambatan apa yang pernah anda jumpai?
A. Hambatan dalam system / proses pelayanan
.........................................................................................................................................................................
.........................................................................................................................................................................
.........................................................................................................................................................................
B. Hambatan dari petugas
.........................................................................................................................................................................
.........................................................................................................................................................................
.........................................................................................................................................................................
C. Hambatan dari pasien
.........................................................................................................................................................................
.........................................................................................................................................................................
.........................................................................................................................................................................

ANGKET HAMBATAN DALAM PELAYANAN KESEHATAN DI PUSKESMAS KELURAHAN JELAMBAR BARU

POLI :

1. Apakah anda pernah mengalami hambatan dalam pelayanan kesehatan pada poli anda?
Ya / Tidak
(*coret yang tidak perlu)
2. Hambatan apa yang pernah anda jumpai?
A. Hambatan dalam system / proses pelayanan
.........................................................................................................................................................................
.........................................................................................................................................................................
.........................................................................................................................................................................
B. Hambatan dari petugas
.........................................................................................................................................................................
.........................................................................................................................................................................
.........................................................................................................................................................................
C. Hambatan dari pasien
.........................................................................................................................................................................
.........................................................................................................................................................................
.........................................................................................................................................................................
.........................................................................................................................................................................