Ticket for Outdoor Patient
| Ward No. 9 | U-PHC No. | Registration No. 04463 | Date 09/06/2021 |
| Token No | SM/21-22/388 09/06/2021 | Serial | 004 |
| Patient Name | Mrs. FULKUMARI SHAW | Contact No | NOT GIVEN |
| Address | 12 BAZAR BYE LANE | Age | 50 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||