Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 04017 | Date 25/08/2020 |
| Token No | SM/19-20/8858 25/08/2020 | Serial | 007 |
| Patient Name | Mrs. KABITA VERMA | Contact No | not given |
| Address | 79 DEY STREET | Age | 60 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||