Ticket for Outdoor Patient
| Ward No. 18 | U-PHC No. | Registration No. 04542 | Date 29/06/2021 |
| Token No | SM/21-22/512 29/06/2021 | Serial | 005 |
| Patient Name | Mrs. PRITI RAUL | Contact No | NOT GIVEN |
| Address | N N COLONY | Age | 26 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||