Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04408 | Date 19/05/2021 |
| Token No | SM/21-22/300 19/05/2021 | Serial | 022 |
| Patient Name | Miss JIYANA PRADHAN | Contact No | NOT GIVEN |
| Address | 9 INDIA JUTE MILL | Age | 9 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||