Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05703 | Date 19/04/2022 |
| Token No | SM/22-23/2722 19/04/2022 | Serial | 013 |
| Patient Name | Mrs. DIVYABHARATHI SAHU | Contact No | 8334880419 |
| Address | 18/105 INDIA JUTE MILL LINE, N L BHATTACHARJEE STREET | Age | 28 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||