Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01577 | Date 15/01/2019 |
| Token No | SM/18-19/2284 15/01/2019 | Serial | 015 |
| Patient Name | Mrs. RANI DEVI | Contact No | 6289953443 |
| Address | 79 DEY ST | Age | 45 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||