Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04394 | Date 18/05/2021 |
| Token No | SM/21-22/276 18/05/2021 | Serial | 007 |
| Patient Name | Mrs. GURIA DEVI | Contact No | 9007095049 |
| Address | 18 A K C BHATTACHARJEE STREET | Age | 22 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||