Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 04955 | Date 29/09/2021 |
| Token No | SM/21-22/1209 29/09/2021 | Serial | 003 |
| Patient Name | Miss MOUSUMI DAS | Contact No | 7890627719 |
| Address | 90c/b DEY STREET | Age | 25 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||