Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05189 | Date 23/12/2021 |
| Token No | SM/21-22/1722 23/12/2021 | Serial | 001 |
| Patient Name | Mrs. MONIKA BHAR | Contact No | 9831467701 |
| Address | 27/A PANDIT KALINATH BHATTACHARJEE STREET | Age | 46 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||