Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 04240 | Date 05/04/2021 |
| Token No | SM/21-22/2103 08/02/2022 | Serial | 004 |
| Patient Name | Miss ANSHIKA KUMARI | Contact No | 8981944375 |
| Address | 79/A DEY STREET | Age | 5 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||