Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04988 | Date 26/10/2021 |
| Token No | SM/21-22/1278 26/10/2021 | Serial | 002 |
| Patient Name | Mrs. SARITA DEBI | Contact No | 8240927542 |
| Address | RAM SITA LINE | Age | 23 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||