Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00751 | Date 20/09/2018 |
| Token No | SM/18-19/4022 07/06/2019 | Serial | 019 |
| Patient Name | Mrs. KAKOLI SARKAR | Contact No | NOT GIVEN |
| Address | 2/3 K.C MUKHERJEE STREET, CHATRA | Age | 46 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||