Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 03176 | Date 14/10/2019 |
| Token No | SM/18-19/6887 14/10/2019 | Serial | 003 |
| Patient Name | Mr. SAMBHU DAS | Contact No | NOT GIVEN |
| Address | 19 PATUA PARA | Age | 69 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||