Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01220 | Date 26/10/2018 |
| Token No | SM/18-19/1643 26/10/2018 | Serial | 011 |
| Patient Name | Miss ANJALI SHA | Contact No | NOT GIVEN |
| Address | RAM SITA LANE | Age | 17 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||