Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01293 | Date 22/11/2018 |
| Token No | SM/18-19/1792 22/11/2018 | Serial | 001 |
| Patient Name | Mr. SHIBAPRASAD DEY | Contact No | 8820673597 |
| Address | DEY STREET | Age | 65 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||