Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03361 | Date 14/11/2019 |
| Token No | SM/18-19/7362 14/11/2019 | Serial | 010 |
| Patient Name | Mrs. SUNITA SHAW | Contact No | 6290390623 |
| Address | 11 NO LINE RAM SITA LINE | Age | 45 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||