Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 05566 | Date 21/03/2022 |
| Token No | SM/21-22/2479 21/03/2022 | Serial | 014 |
| Patient Name | Miss PURNIMA KUMARI | Contact No | NOT GIVEN |
| Address | 7 DEY GHAT LANE | Age | 22 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||