Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01324 | Date 30/11/2018 |
| Token No | SM/18-19/3134 08/04/2019 | Serial | 015 |
| Patient Name | Miss SUPRIYA JAISWARA | Contact No | 7605852744 |
| Address | 7 DEY GHAT LANE | Age | 20 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||