Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 04492 | Date 14/06/2021 |
| Token No | SM/21-22/425 14/06/2021 | Serial | 023 |
| Patient Name | Mrs. SUMAN SHAW | Contact No | NOT GIVEN |
| Address | 36 BARAL BAGAN | Age | 21 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||