Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 04127 | Date 01/03/2021 |
| Token No | SM/21-22/729 27/07/2021 | Serial | 007 |
| Patient Name | Mrs. BINA RANI DAS | Contact No | NOT GIVEN |
| Address | 80 DEY STREET | Age | 70 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||