Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01647 | Date 12/02/2019 |
| Token No | SM/18-19/2802 15/03/2019 | Serial | 003 |
| Patient Name | Master UJJAL METE | Contact No | 7980128858 |
| Address | 11 A. B GARDEN LANE | Age | 18 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||