Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04331 | Date 26/04/2021 |
| Token No | SM/21-22/168 26/04/2021 | Serial | 007 |
| Patient Name | Mr. NAWAL ROY | Contact No | NOT GIVEN |
| Address | RAM SITA LINE | Age | 34 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||