Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01544 | Date 03/01/2019 |
| Token No | SM/18-19/3198 11/04/2019 | Serial | 020 |
| Patient Name | Mr. SUBHAM KOIRI | Contact No | 8481042209 |
| Address | 10 DEY GHAT LANE | Age | 15 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||