Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02266 | Date 14/06/2019 |
| Token No | SM/18-19/6471 16/09/2019 | Serial | 031 |
| Patient Name | Mrs. RITA SHA | Contact No | 6291911264 |
| Address | RAM SITA LANE | Age | 33 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||