Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 04508 | Date 18/06/2021 |
| Token No | SM/21-22/450 18/06/2021 | Serial | 001 |
| Patient Name | Miss ROSHNI KUMARI GUPTA | Contact No | NOT GIVEN |
| Address | 6 RAM SITA LINE | Age | 3 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||