Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 05102 | Date 25/11/2021 |
| Token No | SM/21-22/2467 21/03/2022 | Serial | 002 |
| Patient Name | Mrs. MALINA DAS | Contact No | 8013539564 |
| Address | 22 DHULIPARA | Age | 68 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||