Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00369 | Date 13/08/2018 |
| Token No | SM/19-20/7921 06/12/2019 | Serial | 035 |
| Patient Name | Mrs. G. KAMALA | Contact No | |
| Address | DEY STREET | Age | 65 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||