Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03323 | Date 01/11/2019 |
| Token No | SM/22-23/6390 16/11/2022 | Serial | 020 |
| Patient Name | Mr. RAM SHAW | Contact No | NOT GIVEN |
| Address | DEY STREET | Age | 29 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||