Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05904 | Date 24/05/2022 |
| Token No | SM/22-23/3064 24/05/2022 | Serial | 003 |
| Patient Name | Mrs. SUKANTI BARIK | Contact No | NOT GIVEN |
| Address | INDIA JUTE MILL, 9NO. LINE | Age | 35 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||