Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 04289 | Date 19/04/2021 |
| Token No | SM/21-22/92 19/04/2021 | Serial | 005 |
| Patient Name | Miss SALINI PAL | Contact No | 8013498971 |
| Address | 26 PANCHANAN TALA LANE | Age | 24 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||