Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 05184 | Date 22/12/2021 |
| Token No | SM/25-26/6051 26/10/2026 | Serial | 001 |
| Patient Name | Miss SWAPNA BISWAL | Contact No | 6289801605 |
| Address | RAM SITA LANE | Age | 23 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||