Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 05404 | Date 09/02/2022 |
| Token No | SM/21-22/2114 09/02/2022 | Serial | 003 |
| Patient Name | Miss DALIA NANDAN | Contact No | 8420518294 |
| Address | 7/5 POTUA PARA LANE | Age | 27 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||