Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00984 | Date 17/02/2020 |
| Token No | SM/25-26/12376 26/12/2025 | Serial | 012 |
| Patient Name | Miss AMRITA ADAK | Contact No | 9475100476 |
| Address | AMULYA KANAN SERAMPORE 712203 | Age | 21 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||