Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 04433 | Date 02/06/2021 |
| Token No | SM/21-22/334 02/06/2021 | Serial | 006 |
| Patient Name | Mr. SHIBAM RAM | Contact No | 8910048681 |
| Address | 5 DEY GHAT LANE | Age | 10 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||