Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 04303 | Date 20/04/2021 |
| Token No | SM/21-22/115 20/04/2021 | Serial | 009 |
| Patient Name | Mrs. ALPANA DUTTA | Contact No | NOT GIVEN |
| Address | JITEN LAHIRI ROAD | Age | 19 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||