Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01235 | Date 30/10/2018 |
| Token No | SM/18-19/1680 30/10/2018 | Serial | 032 |
| Patient Name | Miss BANI KUMARI | Contact No | 8622862492 |
| Address | RAM SITA LINE | Age | 16 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||