Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02121 | Date 04/07/2022 |
| Token No | SM/22-23/1045 04/07/2022 | Serial | 012 |
| Patient Name | Miss PURNIMA SHAW | Contact No | 8100469558 |
| Address | 9 NO NAYA BASTI RISHRA | Age | 11 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||