Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03201 | Date 17/10/2019 |
| Token No | SM/25-26/2749 25/11/2025 | Serial | 002 |
| Patient Name | Mr. PAWAN KUMAR | Contact No | NOT GIVEN |
| Address | 18 NO LINE | Age | 12 YRS Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||