Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 00627 | Date 06/09/2018 |
| Token No | SM/18-19/1956 13/12/2018 | Serial | 017 |
| Patient Name | Mr. MOUSAM KUNDU | Contact No | 9748461778 |
| Address | 33, PANDIT K.N BHATTACHARYA STREET | Age | 16 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||