Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02146 | Date 30/05/2019 |
| Token No | SM/18-19/4823 18/07/2019 | Serial | 001 |
| Patient Name | Mrs. LAXMI BISWAL | Contact No | NOT GIVEN |
| Address | 11 DOSTI LANE | Age | 60 Female |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||