Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03469 | Date 22/11/2019 |
| Token No | SM/18-19/7658 22/11/2019 | Serial | 017 |
| Patient Name | Mr. SUVAM KOIRI | Contact No | 7980499087 |
| Address | DEY GHAT LANE | Age | 13 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||