Ticket for Outdoor Patient
| Ward No. 19 | U-PHC No. | Registration No. 12906 | Date 23/04/2025 |
| Token No | SM/25-26/195 23/04/2025 | Serial | 006 |
| Patient Name | Mrs. PINKI BARIK | Contact No | 9830501706 |
| Address | 530 G T ROAD | Age | 27 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||