Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 04935 | Date 27/09/2021 |
| Token No | SM/21-22/1175 27/09/2021 | Serial | 012 |
| Patient Name | Mrs. POLLY CHAKRABORTY | Contact No | 9830882913 |
| Address | 33/1 PATUA PARA | Age | 64 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||