Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00128 | Date 07/08/2018 |
| Token No | SM/18-19/133 07/08/2018 | Serial | 029 |
| Patient Name | Mr. UMESH DAS | Contact No | |
| Address | Age | 44 Male | |
| Token For | Medicine, | Charge | Free |
| B.P | 120/80 mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||