Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02574 | Date 01/07/2019 |
| Token No | SM/18-19/5027 01/07/2019 | Serial | 001 |
| Patient Name | Mr. PREM PRAKASH SRIVASTAV | Contact No | 7003485575 |
| Address | MANIK TALA | Age | 32 Male |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||