Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03655 | Date 02/01/2020 |
| Token No | SM/19-20/8194 02/01/2020 | Serial | 013 |
| Patient Name | Mr. RAJA RAM SHA | Contact No | NOT GIVEN |
| Address | 10 DEY STREET | Age | 65 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 43 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||