Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04209 | Date 30/03/2021 |
| Token No | SM/20-21/9222 30/03/2021 | Serial | 010 |
| Patient Name | Miss SWEETY PRADHAN | Contact No | NOT GIVEN |
| Address | RAM SITA LINE | Age | 9 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||