Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01373 | Date 18/12/2018 |
| Token No | SM/18-19/1977 18/12/2018 | Serial | 003 |
| Patient Name | Mr. CHANDRA KR ROY | Contact No | 8100116911 |
| Address | DEY ST | Age | 18 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||