Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02372 | Date 28/06/2019 |
| Token No | SM/18-19/4514 28/06/2019 | Serial | 004 |
| Patient Name | Miss G RAMIYA | Contact No | NOT GIVEN |
| Address | 18 NO LINE INDIA JUTE MILL | Age | 12 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||