Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01531 | Date 28/12/2018 |
| Token No | SM/18-19/2165 28/12/2018 | Serial | 005 |
| Patient Name | Mr. SK ABULA KALAM | Contact No | 8116377071 |
| Address | JAL KAL | Age | 60 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||