Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 04937 | Date 27/09/2021 |
| Token No | SM/21-22/1178 27/09/2021 | Serial | 015 |
| Patient Name | Mrs. SUKLA MODAK | Contact No | 8272992874 |
| Address | 123 THAKUR BATI STREET | Age | 41 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||