Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02067 | Date 16/05/2019 |
| Token No | SM/21-22/1330 28/10/2021 | Serial | 007 |
| Patient Name | Miss ROSHNI KUMARI | Contact No | 8199931294 |
| Address | NAYA BAGAN 6 RAMSITA LANE | Age | 5 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||