Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01170 | Date 15/09/2018 |
| Token No | SM/18-19/1716 15/09/2018 | Serial | 036 Last Visit: 15/09/2018 |
| Patient Name | Master MD UJALA | Contact No | |
| Address | CHATRA MUSALMAN PARA | Age | 1 YRS 6 MNTH Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||