Ticket for Outdoor Patient
| Ward No. 11 | U-PHC No. | Registration No. 01496 | Date 21/12/2018 |
| Token No | SM/18-19/2281 15/01/2019 | Serial | 012 |
| Patient Name | Mr. PRATAP SANKAR DAS | Contact No | 7998762455 |
| Address | 18 R B SARANI | Age | 61 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||