Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 04502 | Date 15/06/2021 |
| Token No | SM/21-22/439 15/06/2021 | Serial | 009 |
| Patient Name | Baby SANEHA KUMARI | Contact No | NOT GIVEN |
| Address | 5B DEY BARI, 1 DEY GHAT LANE | Age | 5 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||