Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 06569 | Date 30/07/2022 |
| Token No | SM/22-23/13558 05/12/2023 | Serial | 002 |
| Patient Name | Mrs. SUSHAMA KOIRI | Contact No | 7278869737 |
| Address | 79 DEY STREET | Age | 28 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||