Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 02259 | Date 14/06/2019 |
| Token No | SM/18-19/4154 14/06/2019 | Serial | 012 |
| Patient Name | Miss ASTHA KUMARI RAM | Contact No | 8420817629 |
| Address | 7 DEY GHAT LANE | Age | 9 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||