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Phuket Provincial Administrative Organization Hospital
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Patient Complaint / Suggestion
ข้อร้องเรียน / ข้อเสนอแนะจากผู้ใช้บริการ
Complainant's Name
*
Gender
*
Male
Female
Age
*
-- Select --
Under 18
18 - 35
35 - 60
Over 60
Complainant
*
Patient
Relative
Others
Address
Phone
*
Email
Service Type
*
-- Select --
Outpatient (OPD)
Inpatient (IPD)
Department Concerned
*
-- Select --
Staff Concerned
Position
Subject
*
Details
*
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