Ticket for Outdoor Patient
| Ward No. 19 | U-PHC No. | Registration No. 01043 | Date 04/10/2018 |
| Token No | SM/18-19/1357 04/10/2018 | Serial | 016 |
| Patient Name | Mrs. ALPANA ROY | Contact No | NOT GIVEN |
| Address | MAHESH SADGOP PARA | Age | 33 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||