Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 05045 | Date 12/11/2021 |
| Token No | SM/25-26/2715 24/11/2025 | Serial | 002 |
| Patient Name | Mrs. GITA BAG | Contact No | 9073333859 |
| Address | 3 A B GARDEN LANE | Age | 62 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||