Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 06102 | Date 15/06/2022 |
| Token No | SM/22-23/3412 15/06/2022 | Serial | 006 |
| Patient Name | Mrs. GURIA DEBI.... | Contact No | NOT GIVEN |
| Address | RAM SITA LANE, NAYA BAGAN | Age | 32 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||