Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 05391 | Date 03/02/2022 |
| Token No | SM/21-22/2094 03/02/2022 | Serial | 009 |
| Patient Name | Mrs. KAKALI BAIRAGI | Contact No | 9123385920 |
| Address | 46/A POTUA PARA LANE | Age | 45 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||