Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 01823 | Date 28/03/2019 |
| Token No | SM/18-19/2921 28/03/2019 | Serial | 001 |
| Patient Name | Mr. ASHIT PAL | Contact No | NOT GIVEN |
| Address | 7/4 PATUA PARA | Age | 65 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||