Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 02617 | Date 26/07/2019 |
| Token No | SM/18-19/5126 26/07/2019 | Serial | 005 |
| Patient Name | Mrs. RUKMINI AGARWAL | Contact No | NOT GIVEN |
| Address | THAKUR BATI STREET | Age | 46 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||