Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00715 | Date 14/09/2018 |
| Token No | SM/21-22/122 20/04/2021 | Serial | 016 |
| Patient Name | Mrs. ROMILA PRADHAN | Contact No | NOT GIVEN |
| Address | 9 INDIAN JUTE MILL LINE | Age | 41 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||