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English • ಕನ್ನಡ • മലയാളം • हिंदी • தமிழ்
1
Patient Info
2
Service Request
3
Review & Submit

PATIENT INFORMATION

INTERIM SERVICE REQUESTS / COMPLAINTS

Dear [Patient Name],

Please select the category that best matches your concern or request.

Select Category

Admission

Patient Care Feedback - Admission Services

Billing

Patient Care Feedback - Billing Services

Biomedical

Patient Care Feedback - Biomedical

Dietary

Patient Care Feedback - Dietary Services

Discharge

Patient Care Feedback - Discharge Services

Doctor

Patient Care Feedback - Doctor Services

Housekeeping

Patient Care Feedback - Housekeeping Services

Information Technology

Patient Care Feedback - Information Technology

Insurance

Patient Care Feedback - Insurance Services

Laboratory

Patient Care Feedback - Laboratory Services

Maintenance

Patient Care Feedback - Maintenance Services

Nursing

Patient Care Feedback - Nursing Services

OP Pharmacy

Patient Care Feedback - Pharmacy Services

Other services

Patient Care Feedback - Other Services

Radiology

Patient Care Feedback - Radiology Services

REVIEW YOUR DETAILS BEFORE SUBMISSION

Complaint Details

Selected category:
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Concern/Request:
-

Complaint raised in

Floor/Ward:
-
Room/Bed number:
-

Complaint raised by

Patient Name:
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Patient UHID:
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Mobile No:
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