Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01319 | Date 30/11/2018 |
| Token No | SM/18-19/2527 19/02/2019 | Serial | 028 |
| Patient Name | Mr. AJIT DEWAN | Contact No | NOT GIVEN |
| Address | ANNADA BABU GARDEN LANE | Age | 70 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||