Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01636 | Date 08/02/2019 |
| Token No | SM/18-19/2724 08/03/2019 | Serial | 002 |
| Patient Name | Mrs. DURGA DEVI | Contact No | NOT GIVEN |
| Address | DEY ST | Age | 45 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||