Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00753 | Date 20/09/2018 |
| Token No | SM/18-19/1011 20/09/2018 | Serial | 011 |
| Patient Name | Mr. KARTIK DEWAN | Contact No | 8961536660 |
| Address | 8 NO A.B GARDEN LANE | Age | 54 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||