Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02194 | Date 06/06/2019 |
| Token No | SM/18-19/4326 20/06/2019 | Serial | 012 |
| Patient Name | Miss ANSIKA KUMARI | Contact No | NOT GIVEN |
| Address | 79 DEY STREET | Age | 4 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||