Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 06575 | Date 01/08/2022 |
| Token No | SM/22-23/6355 15/11/2022 | Serial | 042 |
| Patient Name | Mrs. BIRAJIN DAS | Contact No | NOT GIVEN |
| Address | DEY STREET, PALBAGAN | Age | 40 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||