Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02814 | Date 16/08/2019 |
| Token No | SM/18-19/5653 16/08/2019 | Serial | 021 |
| Patient Name | Miss SANJANA GUPTA | Contact No | 9038276169 |
| Address | 3 DEY GHAT LANE | Age | 15 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||