Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 04501 | Date 15/06/2021 |
| Token No | SM/21-22/438 15/06/2021 | Serial | 008 |
| Patient Name | Mrs. PRATIMA DUTTA | Contact No | NOT GIVEN |
| Address | DEY STREET, PALBAGAN | Age | 71 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||