Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02132 | Date 28/05/2019 |
| Token No | SM/18-19/4325 20/06/2019 | Serial | 011 |
| Patient Name | Master ANSU KUMARI | Contact No | NOT GIVEN |
| Address | 79/A DEY ST | Age | 8 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||