Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02577 | Date 01/07/2019 |
| Token No | SM/18-19/5030 01/07/2019 | Serial | 004 |
| Patient Name | Mr. RAKESH GUPTA | Contact No | NOT GIVEN |
| Address | SIRISH TALA | Age | 39 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||