Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 01184 | Date 18/09/2018 |
| Token No | SM/18-19/1750 18/09/2018 | Serial | 016 Last Visit: 18/09/2018 |
| Patient Name | Mr. MD ASRAM | Contact No | |
| Address | 53 CHATRA MUSALMAN PARA | Age | 40 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||