Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00974 | Date 27/09/2018 |
| Token No | SM/18-19/1261 27/09/2018 | Serial | 001 |
| Patient Name | Mr. SURAJ DAS | Contact No | 8240008290 |
| Address | 11 DOSTI LANE | Age | 23 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||