KAEBUS / AVALDUS MÄRJAMAA HAIGLALE
Avaldaja andmed:
Nimi: .......................................................................................................................
Postiaadress: ...........................................................................................................
E-post: ....................................................................................................................
Telefon: ..................................................................................................................
Millist haigla osakonda või üksust kaebus/ettepanek puudutab ?
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Kaebuse/ettepaneku sisu ja asjaolude kirjeldus:
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Allkiri: .................................... Kuupäev: ........................