Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00622 | Date 01/09/2018 |
| Token No | SM/18-19/756 01/09/2018 | Serial | 012 |
| Patient Name | Mr. JITTU RAJBHAR | Contact No | |
| Address | 10,DEY GHAT LANE | Age | 30 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||