Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01744 | Date 05/03/2019 |
| Token No | SM/18-19/2678 05/03/2019 | Serial | 010 |
| Patient Name | Mrs. RAMAWATI DEVI | Contact No | NOT GIVEN |
| Address | 7 DEY GHAT LANE | Age | 65 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||