Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01371 | Date 14/12/2018 |
| Token No | SM/18-19/1967 14/12/2018 | Serial | 009 |
| Patient Name | Mr. G. MAHESWAR RAO | Contact No | 9903531379 |
| Address | N.L BHATTACHARYA ST | Age | 33 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||