Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 04976 | Date 22/10/2021 |
| Token No | SM/21-22/1256 22/10/2021 | Serial | 002 |
| Patient Name | Mr. PROTUSH PATWA | Contact No | 7278979878 |
| Address | 79/A DEY STREET | Age | 46 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||