Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03247 | Date 21/10/2019 |
| Token No | SM/19-20/8198 02/01/2020 | Serial | 017 |
| Patient Name | Mrs. MALATI DEBI SINGH | Contact No | NOT GIVEN |
| Address | 6 NO RAM SITA LINE | Age | 52 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||