Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02683 | Date 01/08/2019 |
| Token No | SM/18-19/5327 01/08/2019 | Serial | 018 |
| Patient Name | Mrs. FIROJA BIBI | Contact No | NOT GIVEN |
| Address | BOROBELUR KALTALA | Age | 55 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||