Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 05113 | Date 26/11/2021 |
| Token No | SM/21-22/1516 26/11/2021 | Serial | 003 |
| Patient Name | Miss TRISHA KAR | Contact No | 9051537534 |
| Address | 118 G T ROAD, MANIKTALA.. | Age | 14 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||