- The undersigned hereby applies for an Accreditation Survey by Malaysian Society for Quality in Health (here in after called MSQH).
- The undersigned agrees to facilitate the surveyors appointed by the MSQH to survey the premises, facilities, organisation and operations, including documentation.
- The undersigned hereby acknowledge to have read the Accreditation Survey Application terms and conditions and agrees to all of them.
- The undersigned certifies that the contents of this application form are true and correct.
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CREATE LOGIN ID
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APPLICANT
- Login ID:
- Full Name:
FACILITY PROFILE
Contact Person
Customer Informations
FACILITY DETAILS
Please complete the following details so that the MSQH better assess the composition of the survey team and the length of survey required.
and currently has the following number of dialysis stations where applicable (*please specify number in each type). Please note all dialysis stations must be declared. Should there be any changes prior to the survey, contact the MSQH as soon as possible.
LIST OF SERVICE STANDARD
MISCELLANEOUS
Please provide the following details separately as applicable:
DECLARATION
Person In Charge / Medical Director
- Date:
- 07/11/2024