Ticket for Outdoor Patient
| Ward No. 18 | U-PHC No. | Registration No. 00273 | Date 11/08/2018 |
| Token No | SM/18-19/1504 28/09/2018 | Serial | 053 |
| Patient Name | Mrs. SUNITA PAL | Contact No | |
| Address | 65 NEHARU NAGAR COLONY | Age | 28 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||