Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01267 | Date 01/11/2018 |
| Token No | SM/18-19/1738 01/11/2018 | Serial | 015 |
| Patient Name | Mr. SUSANTA BAG | Contact No | NOT GIVEN |
| Address | A B GARDEN LANE | Age | 48 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||