Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05169 | Date 20/12/2021 |
| Token No | SM/21-22/1668 20/12/2021 | Serial | 002 |
| Patient Name | Mrs. P.BHABANI | Contact No | 8910570296 |
| Address | 18/144 DR. N.L.BHATTACHARJEE STREET | Age | 22 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||