Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02202 | Date 07/06/2019 |
| Token No | SM/25-26/2734 24/11/2025 | Serial | 021 |
| Patient Name | Mrs. MANTI KOIRI | Contact No | 6290264859 |
| Address | 79 DEY STREET | Age | 65 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||