Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04577 | Date 08/07/2021 |
| Token No | SM/21-22/567 08/07/2021 | Serial | 001 |
| Patient Name | Mrs. SASHI BARIK | Contact No | NOT GIVEN |
| Address | 54 NANILAL BHATTACHARJEE STREET | Age | 43 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||