Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04766 | Date 18/08/2021 |
| Token No | SM/21-22/887 18/08/2021 | Serial | 003 |
| Patient Name | Mrs. LALITA DEBI | Contact No | NOT GIVEN |
| Address | 12/527 india jute mill | Age | 45 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||