Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 02853 | Date 20/08/2019 |
| Token No | SM/18-19/5772 20/08/2019 | Serial | 040 |
| Patient Name | Mr. SUMIT DEY | Contact No | 9330012728 |
| Address | 75 DEY STREET | Age | 38 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||