Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01926 | Date 16/04/2019 |
| Token No | SM/19-20/8345 13/01/2020 | Serial | 001 |
| Patient Name | Mrs. BABY SHAW | Contact No | 6289048470 |
| Address | 10 RAM SITA LANE | Age | 46 YRS Female |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||