Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 03209 | Date 17/10/2019 |
| Token No | SM/21-22/1031 01/09/2021 | Serial | 017 |
| Patient Name | Mrs. SUMITRA DAS | Contact No | NOT GIVEN |
| Address | 124/F MANIKTALA | Age | 46 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||