Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 01654 | Date 14/02/2019 |
| Token No | SM/18-19/3620 13/05/2019 | Serial | 014 |
| Patient Name | Miss TRISHA KAR | Contact No | 9051537534 |
| Address | 118 G T ROAD, MANIKTALA.. | Age | 17 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||