Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01316 | Date 29/11/2018 |
| Token No | SM/18-19/1895 06/12/2018 | Serial | 014 |
| Patient Name | Mrs. MANJU DEVI | Contact No | 9062375128 |
| Address | 1 NO INDIA JUTE MILL | Age | 40 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||