Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 04698 | Date 10/08/2021 |
| Token No | SM/21-22/795 10/08/2021 | Serial | 004 |
| Patient Name | Mrs. SHYAMALI SENGUPTA | Contact No | 9051623924 |
| Address | 623 G T ROAD | Age | 53 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||