Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00645 | Date 05/09/2018 |
| Token No | SM/18-19/987 18/09/2018 | Serial | 014 |
| Patient Name | Mr. DHURANDAR RAM | Contact No | NOT GIVEN |
| Address | DEY STREET | Age | 50 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||