Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 05122 | Date 15/05/2019 |
| Token No | SM/22-23/18029 17/11/2022 | Serial | 033 Last Visit: 23/03/2023 |
| Patient Name | Other SUB CENTER OUTREACH | Contact No | |
| Address | ESOPD | Age | 1 Year Other |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||