Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03174 | Date 14/10/2019 |
| Token No | SM/18-19/6885 14/10/2019 | Serial | 001 |
| Patient Name | Miss KAJAL KUMARI | Contact No | 6290132707 |
| Address | RAM SITA LINE | Age | 13 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||