Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01300 | Date 27/11/2018 |
| Token No | SM/18-19/2055 20/12/2018 | Serial | 003 |
| Patient Name | Mrs. K SUSMITA | Contact No | 9331326648 |
| Address | 102 R B SARANI | Age | 26 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||