Ticket for Outdoor Patient
| Ward No. 8 | U-PHC No. | Registration No. 01580 | Date 17/01/2019 |
| Token No | SM/21-22/2188 18/02/2022 | Serial | 002 |
| Patient Name | Mrs. SHANTI DAS | Contact No | NOT GIVEN |
| Address | KHETRASWAR MELA BARI | Age | 50 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||