Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 05768 | Date 28/04/2022 |
| Token No | SM/22-23/2840 28/04/2022 | Serial | 003 |
| Patient Name | Mrs. SITA SHA | Contact No | 8478819210 |
| Address | 6 KUMAR PATTY LANE | Age | 43 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||