Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01034 | Date 04/10/2018 |
| Token No | SM/18-19/1342 04/10/2018 | Serial | 001 |
| Patient Name | Mr. SUPRAKASH GHOSH | Contact No | 9062048796 |
| Address | 8 DEY STREET | Age | 66 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||