Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 01655 | Date 14/02/2019 |
| Token No | SM/18-19/2439 14/02/2019 | Serial | 005 |
| Patient Name | Miss MAMPI DAS | Contact No | 8334824569 |
| Address | 25 BHAGIRATHI LANE MAHESH | Age | 23 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||