Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01975 | Date 25/04/2019 |
| Token No | SM/18-19/3430 29/04/2019 | Serial | 004 |
| Patient Name | Mr. NATABAR PRADHAN | Contact No | NOT GIVEN |
| Address | 9 NO LINE | Age | 64 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||