Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01225 | Date 30/10/2018 |
| Token No | SM/18-19/1659 30/10/2018 | Serial | 011 |
| Patient Name | Mrs. G KALPANA | Contact No | 8013341595 |
| Address | COCKRAIN ROAD | Age | 38 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||