Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02133 | Date 28/05/2019 |
| Token No | SM/18-19/5232 29/07/2019 | Serial | 042 |
| Patient Name | Mrs. RINKU DEVI | Contact No | NOT GIVEN |
| Address | 6 RAM SITA LANE | Age | 35 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||