Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05140 | Date 08/12/2021 |
| Token No | SM/21-22/1577 08/12/2021 | Serial | 006 |
| Patient Name | Mrs. PUJA DEBI.. | Contact No | 9748145099 |
| Address | 6 NAYA BAGAN | Age | 20 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||