Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02127 | Date 28/05/2019 |
| Token No | SM/18-19/3919 03/06/2019 | Serial | 008 |
| Patient Name | Mr. SHIB CHARAN JAISWARA | Contact No | 8981869058 |
| Address | 2 GOPAL GANGULY LANE | Age | 49 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||