Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01332 | Date 04/12/2018 |
| Token No | SM/18-19/3788 24/05/2019 | Serial | 011 |
| Patient Name | Mrs. G. GITA | Contact No | 9903531379 |
| Address | RAM SITA LANE | Age | 33 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||