Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 05151 | Date 14/12/2021 |
| Token No | SM/21-22/1616 14/12/2021 | Serial | 007 |
| Patient Name | Mr. NIMAI MODAK | Contact No | 9477254310 |
| Address | MADAM BAGAN | Age | 45 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||