Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 04610 | Date 14/07/2021 |
| Token No | SM/21-22/622 14/07/2021 | Serial | 012 |
| Patient Name | Mrs. SARALA DEY | Contact No | NOT GIVEN |
| Address | HOPITAL LANE | Age | 77 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||