Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03097 | Date 23/09/2019 |
| Token No | SM/25-26/2173 23/09/2025 | Serial | 010 |
| Patient Name | Mrs. ANIMA DEY | Contact No | NOT GIVEN |
| Address | 4 DEY STREET | Age | 67 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||