Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 04327 | Date 22/04/2021 |
| Token No | SM/24-25/19294 14/10/2024 | Serial | 007 |
| Patient Name | Miss SANGITA DAS | Contact No | NOT GIVEN |
| Address | 100 POTUA PARA | Age | 21 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||