Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01769 | Date 08/03/2019 |
| Token No | SM/18-19/2743 08/03/2019 | Serial | 021 |
| Patient Name | Mr. RAMASANKAR SHAW | Contact No | 7980464213 |
| Address | 12 RAMSITA LANE | Age | 46 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||