Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02486 | Date 18/07/2019 |
| Token No | SM/18-19/4824 18/07/2019 | Serial | 002 |
| Patient Name | Mr. DIPAK TIWARI | Contact No | 7596830881 |
| Address | 76 DEY STREET | Age | 24 Male |
| Token For | Medicine,Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||