Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04310 | Date 21/04/2021 |
| Token No | SM/21-22/131 21/04/2021 | Serial | 005 |
| Patient Name | Mrs. ROZINA BIBI | Contact No | NOT GIVEN |
| Address | K C BHATTACHARJEE STREET | Age | 50 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||