Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 07401 | Date 25/10/2022 |
| Token No | SM/22-23/8114 01/03/2023 | Serial | 010 |
| Patient Name | Miss SAMPALI PAL | Contact No | 9836083879 |
| Address | 3 KASHI DOCTOR LANE | Age | 17 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||