Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 03141 | Date 30/09/2019 |
| Token No | SM/22-23/14391 24/01/2024 | Serial | 011 |
| Patient Name | Mrs. SITA BIYA DEVI | Contact No | NOT GIVEN |
| Address | 126 R.B.SARANI | Age | 57 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||