Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01532 | Date 28/12/2018 |
| Token No | SM/18-19/2168 28/12/2018 | Serial | 008 |
| Patient Name | Mr. SINGHASAN MAHATO | Contact No | NOT GIVEN |
| Address | 19 DOSTI LANE | Age | 65 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||