Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01234 | Date 30/10/2018 |
| Token No | SM/18-19/2994 02/04/2019 | Serial | 004 |
| Patient Name | Miss PRITY KUMARI | Contact No | NOT GIVEN |
| Address | 9 BECHU DEY LANE | Age | 6 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||