Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03323 | Date 01/11/2019 |
| Token No | SM/18-19/7240 01/11/2019 | Serial | 022 |
| Patient Name | Mr. RAM SHAW | Contact No | NOT GIVEN |
| Address | DEY STREET | Age | 29 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||