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1.
Please enter your name
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2.
Are you filling up this survey as your own experience or on behalf of somebody else?
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3.
Your contact e-mail ads
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4.
In which of the following hospitals have you or your relative received treatment in the past year?
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Other (Please Specify)
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5.
Please provide the name of the patient and date of admission
( Patient identity will be kept confidential. However information gathered from this survey will be used to improve observance of patient’s rights in hospitals from Pune city. )
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