Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01345 | Date 06/12/2018 |
| Token No | SM/18-19/1900 06/12/2018 | Serial | 019 |
| Patient Name | Mr. GOBINDA PRADHAN | Contact No | NOT GIVEN |
| Address | PITAMBAR DEY LANE | Age | 50 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||