Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 04718 | Date 12/08/2021 |
| Token No | SM/21-22/826 12/08/2021 | Serial | 011 |
| Patient Name | Miss BABITA SHAW | Contact No | NOT GIVEN |
| Address | 10 DEY STREET | Age | 34 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||