Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 05159 | Date 15/12/2021 |
| Token No | SM/21-22/1640 15/12/2021 | Serial | 001 |
| Patient Name | Mrs. MALATI BANERJEE | Contact No | 8697822401 |
| Address | GOSWAMI PARA, CHAKRABORTY LANE | Age | 62 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||