Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 03757 | Date 22/01/2020 |
| Token No | SM/19-20/8456 22/01/2020 | Serial | 010 |
| Patient Name | Mr. SACHIN RAJBHAR | Contact No | 9330411833 |
| Address | 10 DEY STREET | Age | 14 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||