Ticket for Outdoor Patient
| Ward No. 15 | U-PHC No. | Registration No. 01364 | Date 13/12/2018 |
| Token No | SM/18-19/2379 07/02/2019 | Serial | 020 |
| Patient Name | Mr. SITA RAM BHATTACHARYA | Contact No | 9874391085 |
| Address | 117 G.T ROAD MANIKTALA | Age | 72 Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||