Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02482 | Date 16/07/2019 |
| Token No | SM/18-19/4806 16/07/2019 | Serial | 022 |
| Patient Name | Mr. GONINATH SHA | Contact No | 9748943833 |
| Address | 6 RAM SITA LANE | Age | 62 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||