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1. Apakah anda/keluarga pernah mendapatkan pelayanan di puskesmas
Pleret?a. Belumb. Pernah. Karena
penyakit :...............................................................................................
2. Bagaimana pendapat anda/keluarga tentang bangunan dan sarana yangada di Puskesmas Pleret?......................................................................................................................
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...... ..................3. Apakah anda/keluarga pernah mendapatkan pelayanan Pendaftaran &
kasir Puskesmas Pleret?a. Belum pernah
b. udah pernah. Pendapat anda mengenai pelayanantersebut : ..........................................
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.............................................................!. Apakah anda/keluarga pernah mendapatkan pelayanan di BP "mum
Puskesmas Pleret?a. Belum pernahb. udah pernah. Pendapat anda mengenai pelayanan
tersebut: .........................................................................................................................................................
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..............................................................#. Apakah anda/keluarga pernah mendapatkan pelayanan di BP $igi
Puskesmas Pleret?a. Belum pernahb. udah pernah. Pendapat anda mengenai pelayanan
tersebut: .........................................................................................................................................................
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.............................................................%. Apakah anda/keluarga pernah mendapatkan pelayanan di bagian KA KB
Puskesmas Pleret?a. Belum pernahb. udah pernah. Pendapat anda mengenai pelayanan
tersebut : ..........................................'. ......................................................................................................................
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.................................................(. Apakah anda/keluarga pernah mendapatkan pelayanan di bagian
lab)rat)rium Puskesmas Pleret?a. Belum pernahb. udah pernah. Pendapat anda mengenai pelayanan
tersebut : ...................
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..............................................................*. Apakah anda/keluarga pernah mendapatkan pelayanan di bagian
+armasi/)bat Puskesmas Pleret?
a. Belum pernahb. udah pernah. Pendapat anda mengenai pelayanan
tersebut : ...........................................................................................................................................................
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1,.Apakah anda/keluarga pernah mendapatkan pelayanan balita/-B di
Puskesmas Pleret?a. Belum pernahb. udah pernah. Pendapat anda mengenai pelayanan
tersebut : ...........................................................................................................................................................
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...........................................................11.Apakah anda/keluarga pernah mendapatkan pelayanan si)terapi di
Puskesmas Pleret?0. Belum pernahd. udah pernah. Pendapat anda mengenai pelayanan
tersebut : ................................................................................................................................................................
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.................................................12.Apakah anda/keluarga pernah mendapatkan pelayanan di "$ Puskesmas
Pleret?a. Belum pernahb. udah pernah. Pendapat anda mengenai pelayanan
tersebut: ............................................................................................................................................................
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...........................................................13.Apakah anda/keluarga pernah mendapatkan pelayanan raat inap di
Puskesmas Pleret?a. Belum pernahb. udah pernah. Pendapat anda mengenai pelayanan
tersebut: ............................................................................................................................................................
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...........................................................1!.Apakah anda pernah merasa khaatir akan tertular suatu penyakit saat
anda berada di Puskesmas Pleret?a. Belum pernah
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b. udah pernah. Apakah anda memiliki usulan /saran untuk men0egah
hal tersebut?.................................................................................................................
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1#.-)h)n memberikan kritik dan saran tentang segala sesuatu yang ada diPuskesmas Pleret sarana prasarana4 pelayanan4 -5......................................................................................................................
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