Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03169 | Date 10/10/2019 |
| Token No | SM/18-19/6862 10/10/2019 | Serial | 001 |
| Patient Name | Mr. PRAKASH GUPTA | Contact No | NOT GIVEN |
| Address | 79 DEY STREET | Age | 66 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||