Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05399 | Date 08/02/2022 |
| Token No | SM/21-22/2108 08/02/2022 | Serial | 009 |
| Patient Name | Mrs. GURIA DEBI.. | Contact No | NOT GIVEN |
| Address | 6 RAM SITA LANE | Age | 30 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||