Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01781 | Date 10/03/2019 |
| Token No | SM/18-19/2772 10/03/2019 | Serial | 014 |
| Patient Name | Mr. AJAY RAM | Contact No | NOT GIVEN |
| Address | 7 dey ghat lane | Age | 17 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||