Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 04692 | Date 09/08/2021 |
| Token No | SM/21-22/785 09/08/2021 | Serial | 004 |
| Patient Name | Mrs. PIPASA DAS | Contact No | NOT GIVEN |
| Address | 552 G T ROAD | Age | 29 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||