Ticket for Outdoor Patient
| Ward No. 8 | U-PHC No. | Registration No. 02939 | Date 30/08/2019 |
| Token No | SM/18-19/7318 11/11/2019 | Serial | 002 |
| Patient Name | Mrs. DURGA MODAK | Contact No | 9051487963 |
| Address | 19 BAZAR BYE LANE | Age | 51 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||