Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 04968 | Date 05/10/2021 |
| Token No | SM/21-22/1237 05/10/2021 | Serial | 003 |
| Patient Name | Miss PUNAM KUAMRI SHA | Contact No | 9088454993 |
| Address | 164 NEW MAHESH | Age | 14 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||