Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00679 | Date 13/09/2018 |
| Token No | SM/21-22/1623 14/12/2021 | Serial | 014 |
| Patient Name | Mrs. SHILA DEBI | Contact No | NOT GIVEN |
| Address | BANERJEE PARA | Age | 45 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||