Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02037 | Date 07/05/2019 |
| Token No | SM/18-19/3564 07/05/2019 | Serial | 018 |
| Patient Name | Miss MANISHA KUMARI GUPTA | Contact No | NOT GIVEN |
| Address | 3B DEY ST | Age | 14 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||