Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02389 | Date 01/07/2019 |
| Token No | SM/18-19/4853 18/07/2019 | Serial | 031 |
| Patient Name | Miss SALONI GUPTA | Contact No | NOT GIVEN |
| Address | 12 DEY ST | Age | 10 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||