Ticket for Outdoor Patient
| Ward No. 16 | U-PHC No. | Registration No. 05168 | Date 20/12/2021 |
| Token No | SM/21-22/1890 13/01/2022 | Serial | 007 |
| Patient Name | Mrs. AMBABATI DHARA | Contact No | NOT GIVEN |
| Address | J N LAHIRI ROAD | Age | 63 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||