Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 05187 | Date 22/12/2021 |
| Token No | SM/21-22/1710 22/12/2021 | Serial | 010 |
| Patient Name | Mrs. RUMKI DHOLUI | Contact No | 9748365969 |
| Address | JHAKARI, BORA | Age | 29 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||