Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03036 | Date 13/09/2019 |
| Token No | SM/18-19/6399 13/09/2019 | Serial | 003 |
| Patient Name | Miss MITHI KUMARI | Contact No | not given |
| Address | RAM SITA LINE | Age | 6 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||