Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 05618 | Date 31/03/2022 |
| Token No | SM/21-22/2567 31/03/2022 | Serial | 022 |
| Patient Name | Mrs. PUNAM DEBI SHAW | Contact No | 6289122735 |
| Address | 5 RAJMOHON GOSWAMI LANE | Age | 25 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||