Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02190 | Date 06/06/2019 |
| Token No | SM/22-23/6739 30/11/2022 | Serial | 028 |
| Patient Name | Mrs. GURIYA DEBI | Contact No | NOT GIVEN |
| Address | RAM SITA LANE | Age | 23 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||