Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00754 | Date 20/09/2018 |
| Token No | SM/18-19/1012 20/09/2018 | Serial | 012 |
| Patient Name | Mr. DIBYENDU DEY | Contact No | NOT GIVEN |
| Address | 6 DEY ST | Age | 31 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||