Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01574 | Date 15/01/2019 |
| Token No | SM/18-19/6504 17/09/2019 | Serial | 004 |
| Patient Name | Mrs. ROBI CHANDRAMA | Contact No | NOT GIVEN |
| Address | RAM SITA LANE | Age | 71 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||