Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00735 | Date 18/09/2018 |
| Token No | SM/18-19/988 18/09/2018 | Serial | 015 |
| Patient Name | Master BIKASH JAISWARA | Contact No | 9877565074 |
| Address | 7 NO DEY GHAT LANE | Age | 8 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||