Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01356 | Date 11/12/2018 |
| Token No | SM/18-19/1925 11/12/2018 | Serial | 013 |
| Patient Name | Miss SWAPNA GOT | Contact No | NOT GIVEN |
| Address | 10 DOSTI LANE | Age | 45 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||