Ticket for Outdoor Patient
| Ward No. 19 | U-PHC No. | Registration No. 04512 | Date 21/06/2021 |
| Token No | SM/21-22/956 26/08/2021 | Serial | 021 |
| Patient Name | Miss MOUMITA BHAR | Contact No | 8240610582 |
| Address | 375/1 RAMKRISHNA ROAD, CHATRA | Age | 17 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||