Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 05120 | Date 29/11/2021 |
| Token No | SM/21-22/1530 29/11/2021 | Serial | 005 |
| Patient Name | Mrs. SUSHAMA DAS | Contact No | 9748514307 |
| Address | 26 PANCHANAN TALA LANE | Age | 66 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||