Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 03386 | Date 15/11/2019 |
| Token No | SM/21-22/657 16/07/2021 | Serial | 014 |
| Patient Name | Mrs. SOUMITA SANKHA BANIK | Contact No | 9330937776 |
| Address | 161/1 G T ROAD | Age | 36 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||