Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 01622 | Date 11/10/2018 |
| Token No | SM/19-20/10390 14/09/2019 | Serial | 069 Last Visit: 06/12/2025 |
| Patient Name | Mrs. JOLLY SOM | Contact No | 8017196923 |
| Address | 17B CHATRA DUTTA LANE | Age | 53 Years,1 Months,15 Days Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||