Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 04578 | Date 08/07/2021 |
| Token No | SM/21-22/568 08/07/2021 | Serial | 002 |
| Patient Name | Mrs. USHA SIL | Contact No | NOT GIVEN |
| Address | 15/A PATUA PARA | Age | 65 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||