Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 04481 | Date 14/06/2021 |
| Token No | SM/21-22/413 14/06/2021 | Serial | 011 |
| Patient Name | Mrs. JAGABATI NAYEK | Contact No | 9330152213 |
| Address | J N LAHIRI ROAD | Age | 20 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||