Ticket for Outdoor Patient
| Ward No. 3 | U-PHC No. | Registration No. 01218 | Date 26/10/2018 |
| Token No | SM/18-19/1638 26/10/2018 | Serial | 006 |
| Patient Name | Mr. SUBHAM SARKAR | Contact No | 8777390661 |
| Address | 3/2 K C MUKHERJEE STREET. CHATRA, SERAMPORE | Age | 23 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||