Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 04850 | Date 01/09/2021 |
| Token No | SM/21-22/1026 01/09/2021 | Serial | 012 |
| Patient Name | Miss PUNAM KUMARI.. | Contact No | NOT GIVEN |
| Address | 11/D/1/A SASHI BHUSAN GHOSH LANE | Age | 16 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||