Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 05162 | Date 15/12/2021 |
| Token No | SM/22-23/3898 19/07/2022 | Serial | 021 |
| Patient Name | Mr. DIP RAM.. | Contact No | 8420496341 |
| Address | 4 DEY GHAT LANE | Age | 6 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||