Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01996 | Date 29/04/2019 |
| Token No | SM/18-19/3435 29/04/2019 | Serial | 009 |
| Patient Name | Miss SUMAN KUMARI RAM | Contact No | NOT GIVEN |
| Address | 4 DEY GHAT LANE | Age | 19 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||