Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 05384 | Date 02/02/2022 |
| Token No | SM/21-22/2085 02/02/2022 | Serial | 011 |
| Patient Name | Baby PUSHPA MODOK | Contact No | NOT GIVEN |
| Address | 123 THAKUR BATI STREET | Age | 3 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||