Ticket for Outdoor Patient
| Ward No. 4 | U-PHC No. | Registration No. 05065 | Date 23/11/2021 |
| Token No | SM/21-22/1431 23/11/2021 | Serial | 003 |
| Patient Name | Mrs. KALPANA RUI DAS | Contact No | 7439387901 |
| Address | CHATRA BAGER BAGAN | Age | 38 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||