Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00686 | Date 13/09/2018 |
| Token No | SM/22-23/4554 16/08/2022 | Serial | 029 |
| Patient Name | Mrs. MADHU SOM | Contact No | |
| Address | NOTUN BAGAN LANE | Age | 63 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||