Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 02212 | Date 10/06/2019 |
| Token No | SM/18-19/4044 10/06/2019 | Serial | 012 |
| Patient Name | Mr. BINOD RAM | Contact No | NOT GIVEN |
| Address | 4 DEY GHAT LANE | Age | 35 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||