Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 07099 | Date 21/09/2022 |
| Token No | SM/22-23/5229 21/09/2022 | Serial | 001 |
| Patient Name | Mrs. JHUMURI SWAIN | Contact No | NOT GIVEN |
| Address | 12 PITAMBAR DEY LANE | Age | 34 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||