Ticket for Outdoor Patient
| Ward No. 16 | U-PHC No. | Registration No. 05167 | Date 17/12/2021 |
| Token No | SM/21-22/1665 17/12/2021 | Serial | 010 |
| Patient Name | Miss PUJA DALAL | Contact No | 9339622493 |
| Address | NILMONI GHOSH LANE, MAHESH | Age | 24 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||