Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01260 | Date 01/11/2018 |
| Token No | SM/18-19/1728 01/11/2018 | Serial | 005 |
| Patient Name | Mr. ASHOK PRASAD | Contact No | NOT GIVEN |
| Address | 46 DEY STREET | Age | 64 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||