Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01544 | Date 03/01/2019 |
| Token No | SM/22-23/4363 05/08/2022 | Serial | 012 |
| Patient Name | Mr. SUBHAM KOIRI | Contact No | 8481042209 |
| Address | 10 DEY GHAT LANE | Age | 15 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||