HDU/QA/PMS/FM/001
POST-MARKET SURVEILLANCE CUSTOMER FOLLOW-UP FORM
Human Diagnostics Uganda Limited
Takes less than 1 minute to complete
1. Customer and Device Information:
Facility Name
Please fill in the Facility Name.
Contact Person
Phone:
Email:
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Please fill in this Field.
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Product Model:
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Serial Number:
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Installation Date:
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2. Device User Feedback (
where applicable)
Criteria
Good
Needs Attention
Ease of Use
Result Accuracy
Downtime / Faults
User Satisfaction
3. Issues Noted / Suggested Actions:
Please fill out this field.
4. Additional Comments from Customer:
Please fill out this field.
Thank you! Your feedback helps us serve you better.
Issue date: July 2025
Revision Status: 00
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