Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 04963 | Date 04/10/2021 |
| Token No | SM/21-22/1380 12/11/2021 | Serial | 005 |
| Patient Name | Mrs. SOMA DAS | Contact No | 9007685908 |
| Address | 5 BHAGIRATHI LANE | Age | 42 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||