Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00141 | Date 08/08/2018 |
| Token No | SM/18-19/1912 07/12/2018 | Serial | 011 |
| Patient Name | Mrs. SABITA JAISWARA | Contact No | NOT GIVEN |
| Address | DEY GHAT LANE | Age | 35 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||