Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02603 | Date 25/07/2019 |
| Token No | SM/18-19/5103 25/07/2019 | Serial | 008 |
| Patient Name | Mr. MADHUSUDAN BARAD | Contact No | NOT GIVEN |
| Address | 12 PITAMBAR DEY LANE | Age | 55 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||