Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01326 | Date 30/11/2018 |
| Token No | SM/18-19/1862 30/11/2018 | Serial | 015 |
| Patient Name | Mr. SANTOSH RAM | Contact No | 9534528898 |
| Address | 1 DEY GHAT LANE | Age | 34 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||