Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05129 | Date 02/12/2021 |
| Token No | SM/21-22/1548 02/12/2021 | Serial | 002 |
| Patient Name | Mrs. JUBEDA BIBI.. | Contact No | 9331826540 |
| Address | LALIT MOHON BHATTACHARHJEE STREET | Age | 31 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||