Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01982 | Date 26/04/2019 |
| Token No | SM/18-19/4134 13/06/2019 | Serial | 024 |
| Patient Name | Mrs. MAMATA RAM | Contact No | NOT GIVEN |
| Address | 7 DEY GHAT LANE | Age | 22 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||