Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 04619 | Date 15/07/2021 |
| Token No | SM/21-22/643 15/07/2021 | Serial | 017 |
| Patient Name | Mrs. CHABI MANNA | Contact No | 9475719573 |
| Address | 32B CHOWDHURY PARA LANE | Age | 57 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||