Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 03381 | Date 14/11/2019 |
| Token No | SM/18-19/7401 14/11/2019 | Serial | 049 |
| Patient Name | Mr. KANHAIYA SHA | Contact No | 8910037619 |
| Address | 6 RAM SITA LANE NAYA BAGAN | Age | 29 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||