Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01337 | Date 04/12/2018 |
| Token No | SM/18-19/1939 11/12/2018 | Serial | 027 |
| Patient Name | Mrs. CHAMPA JANA | Contact No | NOT GIVEN |
| Address | TARAKESWAT | Age | 45 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 60 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||