Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03155 | Date 01/10/2019 |
| Token No | SM/21-22/349 03/06/2021 | Serial | 009 |
| Patient Name | Master AKANSHA SHAW | Contact No | NOT GIVEN |
| Address | DEY STREET | Age | 13 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||