Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 03142 | Date 30/09/2019 |
| Token No | SM/18-19/6779 30/09/2019 | Serial | 004 |
| Patient Name | Mrs. CHINTA DEBI | Contact No | NOT GIVEN |
| Address | 126 R.B.SARANI | Age | 30 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||