Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 05000 | Date 27/10/2021 |
| Token No | SM/21-22/1309 27/10/2021 | Serial | 011 |
| Patient Name | Mrs. KAJAL MAKAL | Contact No | NOT GIVEN |
| Address | 8A BROJO DUTTA LANE | Age | 36 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||