Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02229 | Date 11/06/2019 |
| Token No | SM/18-19/4080 11/06/2019 | Serial | 011 |
| Patient Name | Miss PRIYASHA BHOL | Contact No | 9681660305 |
| Address | 9 INDIA JUTE MILL | Age | 10 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||