Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 05425 | Date 14/02/2022 |
| Token No | SM/21-22/2149 14/02/2022 | Serial | 007 |
| Patient Name | Miss PRIYA KUMARI MODI | Contact No | 6289963036 |
| Address | 2N/1 SASHIBHUSHAN GHOSH LANE | Age | 17 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||