Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 02675 | Date 31/07/2019 |
| Token No | SM/25-26/6071 26/10/2026 | Serial | 021 |
| Patient Name | Mrs. SREERUPA GOSWAMI | Contact No | 8697390899 |
| Address | 107A THAKUR BATI STREET | Age | 35 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||