Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 00656 | Date 11/09/2018 |
| Token No | SM/18-19/2171 28/12/2018 | Serial | 011 |
| Patient Name | Mr. BASU DEV DAS | Contact No | 9830706830 |
| Address | 120 MANIK TALA | Age | 70 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||