Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 04728 | Date 16/08/2021 |
| Token No | SM/21-22/841 16/08/2021 | Serial | 005 |
| Patient Name | Mrs. MOUSUMI BAG | Contact No | 8697669189 |
| Address | 3 PITAMBAR DEY LANE | Age | 24 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||