Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03187 | Date 15/10/2019 |
| Token No | SM/18-19/6914 15/10/2019 | Serial | 006 |
| Patient Name | Master BISHAL MANJHI | Contact No | 8479971460 |
| Address | 9 RAM SITA LANE | Age | 4 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||