Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00737 | Date 18/09/2018 |
| Token No | SM/18-19/990 18/09/2018 | Serial | 017 |
| Patient Name | Mrs. RAMAWATI DEVI | Contact No | |
| Address | DEY GHAT LANE | Age | 52 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||