Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 04393 | Date 18/05/2021 |
| Token No | SM/21-22/275 18/05/2021 | Serial | 006 |
| Patient Name | Mrs. SAKILA BEGUM | Contact No | 9123674579 |
| Address | 80/A/1/A DEY STREET | Age | 18 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||