Ticket for Outdoor Patient
| Ward No. 18 | U-PHC No. | Registration No. 12976 | Date 12/05/2025 |
| Token No | SM/25-26/424 12/05/2025 | Serial | 002 |
| Patient Name | Miss ROSEMARY GOMES | Contact No | 9903291058 |
| Address | 177 NEHERU NAGAR COLONY | Age | 16 YRS Female |
| Token For | Visit Doctor,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||