Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04489 | Date 14/06/2021 |
| Token No | SM/21-22/422 14/06/2021 | Serial | 020 |
| Patient Name | Mrs. PAMPA BHAR | Contact No | 9007759694 |
| Address | 41 RISHI BANKIM SARANI | Age | 33 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||