Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00161 | Date 18/08/2018 |
| Token No | SM/18-19/1976 18/12/2018 | Serial | 002 |
| Patient Name | Mrs. SARASWATI JENNA | Contact No | NOT GIVEN |
| Address | INDIA JUTE MILL | Age | 32 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||