Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 02126 | Date 28/05/2019 |
| Token No | SM/18-19/3827 28/05/2019 | Serial | 001 |
| Patient Name | Mr. SEWMOHAR MANJHI | Contact No | 9051045548 |
| Address | 80A/1 DEY ST | Age | 56 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||