Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00097 | Date 06/08/2018 |
| Token No | SM/21-22/1662 17/12/2021 | Serial | 007 |
| Patient Name | Mrs. KUNTALA BISWAL | Contact No | 9836010315 |
| Address | 9,INDIAN JUTE MILL | Age | 60 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||