Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 08028 | Date 27/12/2022 |
| Token No | SM/22-23/7186 27/12/2022 | Serial | 030 |
| Patient Name | Miss CHIKU SHA | Contact No | NOT GIVEN |
| Address | NAYA BAGAN | Age | 5 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||