Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02131 | Date 28/05/2019 |
| Token No | SM/18-19/4122 13/06/2019 | Serial | 012 |
| Patient Name | Miss LUCKY KUMARI | Contact No | NOT GIVEN |
| Address | 79 DEY ST | Age | 9 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||