Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 03172 | Date 10/10/2019 |
| Token No | SM/19-20/7757 29/11/2019 | Serial | 020 |
| Patient Name | Mr. SANTOSH RAM | Contact No | NOT GIVEN |
| Address | 1 DEY GHAT LANE | Age | 34 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 61 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||