Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 04687 | Date 05/08/2021 |
| Token No | SM/22-23/3022 19/05/2022 | Serial | 005 |
| Patient Name | Mrs. LALITA BISWAS | Contact No | NOT GIVEN |
| Address | 4 KASHI DOCTOR LANE | Age | 64 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||