Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 03139 | Date 30/09/2019 |
| Token No | SM/18-19/6776 30/09/2019 | Serial | 001 |
| Patient Name | Mr. RATAN DAS | Contact No | NOT GIVEN |
| Address | 37 AKHRA BATI LANE | Age | 47 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||