Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03109 | Date 24/09/2019 |
| Token No | SM/20-21/9254 31/03/2021 | Serial | 026 |
| Patient Name | Miss KIRTIKA BISWAL | Contact No | NOT GIVEN |
| Address | N.L.BHATTACHARYA ST | Age | 3 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||