Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 02872 | Date 22/08/2019 |
| Token No | SM/18-19/5825 22/08/2019 | Serial | 003 |
| Patient Name | Mr. RAM MILAN | Contact No | NOT GIVEN |
| Address | 7 DEY STREET | Age | 55 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||