Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03463 | Date 21/11/2019 |
| Token No | SM/18-19/7640 21/11/2019 | Serial | 061 |
| Patient Name | Miss SUNITA BISWAL | Contact No | NOT GIVEN |
| Address | 19 DEY STREET | Age | 25 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 47 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||