Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01702 | Date 21/02/2019 |
| Token No | SM/22-23/5667 19/10/2022 | Serial | 004 |
| Patient Name | Mrs. DURGA SHAW | Contact No | 9875502737 |
| Address | 59 L M BHATTACHARJEE STREET | Age | 40 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||