Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02173 | Date 04/06/2019 |
| Token No | SM/22-23/7954 20/02/2023 | Serial | 012 |
| Patient Name | Mrs. G APPALAM | Contact No | NOT GIVEN |
| Address | 12 PITAMBAR DEY LANE | Age | 51 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||