Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 05348 | Date 27/01/2022 |
| Token No | SM/21-22/2006 27/01/2022 | Serial | 004 |
| Patient Name | Miss KOYEL DAS | Contact No | 9883872821 |
| Address | 60 DEY STREET | Age | 12 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||