Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01233 | Date 30/10/2018 |
| Token No | SM/18-19/1978 18/12/2018 | Serial | 004 |
| Patient Name | Mr. SAMARENDRA KUNDU | Contact No | 974861778 |
| Address | 33 PANDIT K.N BHATTACHARYA STREET | Age | 40 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||