Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02102 | Date 21/05/2019 |
| Token No | SM/18-19/3757 21/05/2019 | Serial | 010 |
| Patient Name | Mr. AMIT RAJBHAR | Contact No | 9477417044 |
| Address | 11 DEY ST | Age | 22 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||