Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 03140 | Date 30/09/2019 |
| Token No | SM/21-22/719 26/07/2021 | Serial | 013 |
| Patient Name | Mrs. RINA DAS | Contact No | NOT GIVEN |
| Address | MANIKTALA | Age | 42 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||