Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01683 | Date 15/02/2019 |
| Token No | SM/18-19/3036 04/04/2019 | Serial | 011 |
| Patient Name | Master RAJA BAG | Contact No | NOT GIVEN |
| Address | 4 A B GARDEN LANE | Age | 18 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||