Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05709 | Date 19/04/2022 |
| Token No | SM/22-23/2729 19/04/2022 | Serial | 020 |
| Patient Name | Mrs. KAKALI ROY | Contact No | 9874697744 |
| Address | 43/A DEY STREET | Age | 31 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||