Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03768 | Date 25/01/2020 |
| Token No | SM/21-22/194 28/04/2021 | Serial | 012 |
| Patient Name | Mrs. GULABI DEBI | Contact No | NOT GIVEN |
| Address | DEY GHAT LANE | Age | 62 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||