Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03623 | Date 16/12/2019 |
| Token No | SM/21-22/1528 29/11/2021 | Serial | 003 |
| Patient Name | Miss SUPRIYA JAISWARA.. | Contact No | 9875650744 |
| Address | 7 DEY GHAT LANE | Age | 19 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||