Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03078 | Date 19/09/2019 |
| Token No | SM/18-19/6565 19/09/2019 | Serial | 025 |
| Patient Name | Mrs. SOVA DEBI | Contact No | 9007783517 |
| Address | 6 RAM SITA LANE | Age | 45 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||