Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00450 | Date 14/08/2018 |
| Token No | SM/18-19/3219 12/04/2019 | Serial | 012 |
| Patient Name | Mrs. ASHA RAM | Contact No | 9869584715 |
| Address | 7 DEY GHAT LANE | Age | 42 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||