Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 05016 | Date 28/10/2021 |
| Token No | SM/21-22/2185 17/02/2022 | Serial | 010 |
| Patient Name | Mrs. SHIPRA CHAKRABORTY | Contact No | NOT GIVEN |
| Address | 5A KAILASH CHATTERJEE LANE | Age | 62 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||