Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 01749 | Date 07/03/2019 |
| Token No | SM/18-19/2690 07/03/2019 | Serial | 002 |
| Patient Name | Mr. DARPAN DE | Contact No | 9239437648 |
| Address | 107G PATUA PARA LANE | Age | 48 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||