Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04843 | Date 01/09/2021 |
| Token No | SM/21-22/1017 01/09/2021 | Serial | 003 |
| Patient Name | Miss SRINJOYI BHAR | Contact No | 9830695967 |
| Address | 37 DEY STREET | Age | 15 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||