Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00962 | Date 25/09/2018 |
| Token No | SM/18-19/1246 25/09/2018 | Serial | 008 |
| Patient Name | Mr. MISTRI LAL PRASAD | Contact No | 867588467 |
| Address | 3 DEY GHAT LANE | Age | 65 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||