Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00612 | Date 21/08/2018 |
| Token No | SM/25-26/2044 15/09/2025 | Serial | 001 |
| Patient Name | Mrs. LAXMI LOO | Contact No | 9038777439 |
| Address | 14/B DEY STREET | Age | 50 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||