Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00660 | Date 11/09/2018 |
| Token No | SM/18-19/1634 26/10/2018 | Serial | 002 |
| Patient Name | Mr. SURENDAR SINGH | Contact No | 8981514011 |
| Address | 16 KAILASH CHATTERJEE LANE | Age | 55 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||