Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 05013 | Date 28/10/2021 |
| Token No | SM/21-22/1327 28/10/2021 | Serial | 004 |
| Patient Name | Master DIP RAM | Contact No | 8013548536 |
| Address | 4 DEY GHAT LANE | Age | 6 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||