Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 00295 | Date 09/08/2018 |
| Token No | SM/18-19/1724 01/11/2018 | Serial | 001 |
| Patient Name | Mr. TARAK DEVNATH | Contact No | 9062606406 |
| Address | 28 NIL MANI GHOSH LANE | Age | 58 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||