Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01268 | Date 01/11/2018 |
| Token No | SM/18-19/1739 01/11/2018 | Serial | 016 |
| Patient Name | Miss KAJAL KUMARI | Contact No | 7596822544 |
| Address | 8C/5 DEY STREET | Age | 13 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||