Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 04635 | Date 19/07/2021 |
| Token No | SM/21-22/674 19/07/2021 | Serial | 017 |
| Patient Name | Mr. RAHUL RAM | Contact No | 6290849432 |
| Address | 4 DEY GHAT LANE | Age | 24 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||