Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03717 | Date 08/01/2020 |
| Token No | SM/19-20/8636 04/03/2020 | Serial | 012 |
| Patient Name | Miss KHUSI KUMARI | Contact No | NOT GIVEN |
| Address | 4 DEY GHAT LANE | Age | 13 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 27 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||