Compliments & Complaints / Izibongo Nezikhalazo
LPH reporting mechanism, where we will give you feedback within 7 working days, if you provide contact details. / Inqubo yokubika ye-LPH. Sizokunikeza impendulo phakathi kwezinsuku ezi-7 zokusebenza uma usishiya imininingwane yakho yokuxhumana.
Name (optional) / Igama (uma ufuna)
First Name / Igama
Last Name / Isibongo
Email (should you want feedback) / I-imeyili (uma ufuna impendulo)
example@example.com
Phone Number (optional) / Ucingo (uma ufuna)
Format: (000) 000-0000.
Date of submission / Usuku Lokuletha Umbiko
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Day
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Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Type of Report / Uhlobo Lombiko
Complaint / Isikhalazo
Compliment / Izibongo
Suggestion / Isiphakamiso
Whistleblower / Ukubika Okufihlekile
The event leading to this report: / Umcimbi oholele kulo mbiko:
Please describe the event: / Chaza umcimbi:
Event: / Umcimbi:
Event pertaining to: / Umcimbi othinta:
Hospital Care / Ukunakekelwa Esibhedlela
Health Professional / Udokotela noma Umsebenzi Wezempilo
Staff Member / Umsebenzi Wesibhedlela
Medical Aid / I-Medical Aid
Other / Okunye
Name of Hospital and individual: / Igama Lesibhedlela Nomuntu
Date of event / Usuku Lomcimbi
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date / Usuku
Your expected outcome: / Umphumela Olindelekile:
"When the whole world is silent, even one voice becomes powerful." / “Uma umhlaba wonke uthule, izwi elilodwa lingaba namandla.”
-Malala Yousafzia-
Submit
Should be Empty: