Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01921 | Date 16/04/2019 |
| Token No | SM/18-19/3237 16/04/2019 | Serial | 006 |
| Patient Name | Miss NISHA SINGH | Contact No | NOT GIVEN |
| Address | 20 DEY ST | Age | 20 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||