Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 04786 | Date 23/08/2021 |
| Token No | SM/21-22/916 23/08/2021 | Serial | 011 |
| Patient Name | Miss KOMAL DAS | Contact No | 9163765061 |
| Address | 7 DEY GHAT LANE | Age | 9 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||