Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01035 | Date 04/10/2018 |
| Token No | SM/18-19/1344 04/10/2018 | Serial | 003 |
| Patient Name | Miss SUMAN SINGH | Contact No | NOT GIVEN |
| Address | 1 DEY GHAT LANE | Age | 18 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||