Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01322 | Date 30/11/2018 |
| Token No | SM/25-26/6104 28/10/2026 | Serial | 024 |
| Patient Name | Mrs. SANDHYA NATH | Contact No | NOT GIVEN |
| Address | PAL BAGAN, DEY STREET | Age | 50 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||