Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01561 | Date 10/01/2019 |
| Token No | SM/18-19/3578 10/05/2019 | Serial | 004 |
| Patient Name | Mrs. SOVA SINHA | Contact No | 8584937938 |
| Address | 34A KASHI DOCTOR LANE | Age | 60 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||