Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 06373 | Date 19/07/2022 |
| Token No | SM/22-23/3890 19/07/2022 | Serial | 013 |
| Patient Name | Mrs. GOURI RANI KHATWA | Contact No | 8017278346 |
| Address | 28/5 SASHI BHUSAN GHOSH LANE | Age | 50 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||