Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 02517 | Date 13/12/2018 |
| Token No | SM/18-19/5209 13/12/2018 | Serial | 056 Last Visit: 21/01/2019 |
| Patient Name | Mr. RIZWAN ANSARI | Contact No | 7890067950 |
| Address | 19 T.C. GOSWAMI STREET | Age | 34 Y Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 50 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||