Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01294 | Date 22/11/2018 |
| Token No | SM/19-20/8423 17/01/2020 | Serial | 014 |
| Patient Name | Mr. JAY PRAKASH RAY | Contact No | 8013280906 |
| Address | 180 QUATER, RAM SITA LANE | Age | 47 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 52 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||