Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00976 | Date 27/09/2018 |
| Token No | SM/18-19/1483 28/09/2018 | Serial | 032 |
| Patient Name | Mrs. KUNTI JANA | Contact No | NOT GIVEN |
| Address | 9 NO LINE | Age | 50 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||