Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04420 | Date 01/06/2021 |
| Token No | SM/21-22/314 01/06/2021 | Serial | 003 |
| Patient Name | Mrs. KUSUM DEBI | Contact No | 6290849750 |
| Address | 5B DEY BARI | Age | 25 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||