Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00139 | Date 08/08/2018 |
| Token No | SM/19-20/8422 17/01/2020 | Serial | 013 |
| Patient Name | Mrs. ASHA DEBI | Contact No | 8013280906 |
| Address | RAM SITA LANE | Age | 34 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 33 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||