Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 01530 | Date 28/12/2018 |
| Token No | SM/18-19/2164 28/12/2018 | Serial | 004 |
| Patient Name | Miss G HARIKA | Contact No | 9088104341 |
| Address | 106 R B SARABNI | Age | 9 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||