Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 05642 | Date 04/04/2022 |
| Token No | SM/22-23/5183 19/09/2022 | Serial | 002 |
| Patient Name | Master DIP RAM... | Contact No | NOT GIVEN |
| Address | 4 DEY GHAT LANE | Age | 4 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||