Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03570 | Date 06/12/2019 |
| Token No | SM/19-20/7912 06/12/2019 | Serial | 026 |
| Patient Name | Miss ASTHA KUMARI RAM | Contact No | 9163765061 |
| Address | 7 DEY GHAT LANE | Age | 15 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||