Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01998 | Date 29/04/2019 |
| Token No | SM/18-19/3777 23/05/2019 | Serial | 011 |
| Patient Name | Miss KHUSHI KUMARI RAM | Contact No | NOT GIVEN |
| Address | 4 DEY GHAT LANE | Age | 8 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||