Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 05489 | Date 03/03/2022 |
| Token No | SM/21-22/2308 03/03/2022 | Serial | 014 |
| Patient Name | Miss FALGUNI BAG | Contact No | NOT GIVEN |
| Address | 4 A B GARDEN LANE | Age | 14 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||