Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 02337 | Date 24/06/2019 |
| Token No | SM/18-19/4593 05/07/2019 | Serial | 001 |
| Patient Name | Mr. M.N.SUR | Contact No | 9674153382 |
| Address | 10A THAKURBATI ST | Age | 65 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||