Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 04293 | Date 19/04/2021 |
| Token No | SM/21-22/101 19/04/2021 | Serial | 014 |
| Patient Name | Mrs. KAKALI PAN | Contact No | NOT GIVEN |
| Address | 63/A BHAGIRATHI LANE | Age | 47 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||