Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 01777 | Date 10/03/2019 |
| Token No | SM/18-19/2901 19/03/2019 | Serial | 035 |
| Patient Name | Mrs. RENUKA SHA | Contact No | 8777468154 |
| Address | GARULIA PINCOL SHYAMNAGAR | Age | 50 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||