Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 01036 | Date 04/10/2018 |
| Token No | SM/18-19/1346 04/10/2018 | Serial | 005 |
| Patient Name | Mr. BACHHU DAS | Contact No | NOT GIVEN |
| Address | MANIKTALA | Age | 52 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||