Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01051 | Date 05/10/2018 |
| Token No | SM/18-19/4321 20/06/2019 | Serial | 007 |
| Patient Name | Mrs. DIMPLE JAISWARA | Contact No | 8585876025 |
| Address | 7 DEY GHAT LANE | Age | 28 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||