Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02613 | Date 26/07/2019 |
| Token No | SM/18-19/5122 26/07/2019 | Serial | 001 |
| Patient Name | Miss SUCHARITA ADHYA | Contact No | 9687457896 |
| Address | BANERJEE PARA | Age | 26 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||