Ticket for Outdoor Patient
| Ward No. 26 | U-PHC No. | Registration No. 02650 | Date 29/07/2019 |
| Token No | SM/18-19/5230 29/07/2019 | Serial | 040 |
| Patient Name | Master GANESH SHAH | Contact No | NOT GIVEN |
| Address | 55 NO RAY LANE ROAD | Age | 8 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||