Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02092 | Date 20/05/2019 |
| Token No | SM/18-19/6041 30/08/2019 | Serial | 024 |
| Patient Name | Mrs. GOURI BANERJEE | Contact No | 9681802222 |
| Address | 29 R.B. SARANI | Age | 77 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||