Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00149 | Date 08/08/2018 |
| Token No | SM/18-19/157 08/08/2018 | Serial | 023 |
| Patient Name | Mr. AMIT DAS | Contact No | NOT GIVEN |
| Address | 118 G T ROAD, MANIKTALA | Age | 45 Male |
| Token For | Medicine, | Charge | Free |
| B.P | 140/70 mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||