Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 01740 | Date 29/10/2018 |
| Token No | SM/18-19/3733 15/11/2018 | Serial | 028 Last Visit: 15/11/2018 |
| Patient Name | Mr. JASIN RAJA | Contact No | 9748284723 |
| Address | 24, PARSI LANE SILBAGAN | Age | 11 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 24 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||