Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04748 | Date 17/08/2021 |
| Token No | SM/21-22/866 17/08/2021 | Serial | 009 |
| Patient Name | Miss PRIYASHA BHOL | Contact No | NOT GIVEN |
| Address | N L BHATTACHARJEE STREET | Age | 11 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||