Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 04034 | Date 22/09/2020 |
| Token No | SM/21-22/1199 28/09/2021 | Serial | 011 |
| Patient Name | Mrs. BABY SADHUKHAN | Contact No | NOT GIVEN |
| Address | 52/A DHULI PARA LANE | Age | 55 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||