Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03430 | Date 19/11/2019 |
| Token No | SM/18-19/7514 19/11/2019 | Serial | 011 |
| Patient Name | Miss SUSHAMA SINGH | Contact No | 9433820909 |
| Address | 17 DOSTI LANE, PAL BAGAN | Age | 19 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 65 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||