Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 02005 | Date 30/04/2019 |
| Token No | SM/18-19/3560 07/05/2019 | Serial | 014 |
| Patient Name | Mr. RAHUL RAM | Contact No | NOT GIVEN |
| Address | 4 DEY GHAT LANE | Age | 19 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||