Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 00475 | Date 14/08/2018 |
| Token No | SM/18-19/1952 13/12/2018 | Serial | 013 |
| Patient Name | Mr. DIBYENDU GHOSHAL | Contact No | 9007596109 |
| Address | 24A BHAGIRATHI LANE | Age | 49 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||