Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03034 | Date 12/09/2019 |
| Token No | SM/22-23/8610 28/03/2023 | Serial | 017 |
| Patient Name | Mrs. CHANDA DEBI | Contact No | not given |
| Address | 12 NO LINE | Age | 70 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||