Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01449 | Date 20/12/2018 |
| Token No | SM/18-19/2062 20/12/2018 | Serial | 010 |
| Patient Name | Mr. JAGINDAR ROY | Contact No | NOT GIVEN |
| Address | JAL KAL WORKER | Age | 35 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||