Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 04944 | Date 28/09/2021 |
| Token No | SM/21-22/1190 28/09/2021 | Serial | 002 |
| Patient Name | Miss ROSHONI DAS | Contact No | 9883670314 |
| Address | 78 DEY STREET | Age | 18 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||