Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 03320 | Date 01/11/2019 |
| Token No | SM/18-19/7232 01/11/2019 | Serial | 014 |
| Patient Name | Mrs. USHA RANI DALAL | Contact No | 9432168161 |
| Address | 25 BHAGIRATHI LANE | Age | 74 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||