Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 04345 | Date 28/04/2021 |
| Token No | SM/21-22/192 28/04/2021 | Serial | 010 |
| Patient Name | Miss SAHELI SRIMANI | Contact No | NOT GIVEN |
| Address | 2/A K.C.BHATTACHARJEE STREET | Age | 23 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||