Ticket for Outdoor Patient
| Ward No. 18 | U-PHC No. | Registration No. 04919 | Date 24/09/2021 |
| Token No | SM/21-22/1152 24/09/2021 | Serial | 003 |
| Patient Name | Miss ISHITA BANERJEE | Contact No | NOT GIVEN |
| Address | 164 N N COLONY | Age | 12 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||