Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 02924 | Date 28/08/2019 |
| Token No | SM/18-19/5992 28/08/2019 | Serial | 012 |
| Patient Name | Mr. PROVAU NATH SHA | Contact No | 9470871067 |
| Address | 18/20 INDIA JUTE MIL LANE | Age | 70 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||