Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05136 | Date 07/12/2021 |
| Token No | SM/21-22/1569 07/12/2021 | Serial | 011 |
| Patient Name | Mrs. PUTUL DAS | Contact No | 9433120174 |
| Address | 33 LALIT MOHON BHATTACHARJEE STREET | Age | 36 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||