Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01645 | Date 23/05/2022 |
| Token No | SM/22-23/71 23/05/2022 | Serial | 040 |
| Patient Name | Mr. NETI SHAW | Contact No | |
| Address | 6 NO HUMOR PATTY LANE SERAMPORE | Age | 8 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||