Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04500 | Date 15/06/2021 |
| Token No | SM/21-22/436 15/06/2021 | Serial | 006 |
| Patient Name | Mrs. SHAMPA RAJBHAR | Contact No | 8444904288 |
| Address | 10 DEY STREET | Age | 27 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||