Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02265 | Date 14/06/2019 |
| Token No | SM/18-19/6263 06/09/2019 | Serial | 011 |
| Patient Name | Mr. AMIT SHA | Contact No | 6291911264 |
| Address | RAMSITA LANE | Age | 34 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||