Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 04890 | Date 07/09/2021 |
| Token No | SM/25-26/384 07/05/2025 | Serial | 006 |
| Patient Name | Mr. RAM DULAR RAM | Contact No | NOT GIVEN |
| Address | 7 DEY GHAT LANE | Age | 75 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||