Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01227 | Date 30/10/2018 |
| Token No | SM/18-19/4322 20/06/2019 | Serial | 008 |
| Patient Name | Mr. SAMIR JAISWARA | Contact No | 8585876025 |
| Address | 7 DEY GHAT LANE | Age | 31 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||