Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04399 | Date 19/05/2021 |
| Token No | SM/21-22/281 19/05/2021 | Serial | 003 |
| Patient Name | Mrs. DULARI KHATIK | Contact No | NOT GIVEN |
| Address | RAM SITA LINE | Age | 51 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||