Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 01529 | Date 28/12/2018 |
| Token No | SM/18-19/2163 28/12/2018 | Serial | 003 |
| Patient Name | Master GANESH DAS | Contact No | 9088104341 |
| Address | 106 R B SARANI | Age | 8 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||