Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01167 | Date 04/09/2018 |
| Token No | SM/18-19/1573 04/09/2018 | Serial | 029 |
| Patient Name | Mr. SK SALAM | Contact No | 8820394467 |
| Address | 26 K C BHATTACHARYA STREET | Age | 63 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||